Form Ar1000nr - Arkansas Individual Income Tax Return Nonresident And Part Year Resident - 2003 Page 2

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(A)
Your/Total
(B)
Spouse Income
Income
Status 4 Only
35.
ADJUSTED GROSS INCOME: (From Line 34, Columns A and B, Page NR1) ........................ 35
00
35
00
36.
Select tax table: (Check the appropriate box)
LOW INCOME Table 1
REGULAR Table 2
If you qualify for the Low Income Tax Table, enter zero (0) on Line 36A. If not, then:
}
Itemized Deductions (See itemized deduction schedule, Line 28)
Enter
the larger
OR
Standard Deduction (See Standard Deduction Instr., Line 36) .......... 36
of your:
00
36
00
37.
NET TAXABLE INCOME: (Subtract Line 36 from Line 35) ...................................................... 37
00
37
00
38.
Tax: (Enter tax from tax table) .............................................................................................. 38
00
38
00
39.
Combined tax: (Add amounts from Lines 38A and 38B and enter here) ................................................................................. 39
00
40.
Income Tax Surcharge: (Multiply Line 39 by 3% (.03);
TEXARKANA RESIDENTS MUST USE SURCHARGE
SCHEDULE) ... 40
00
41.
Enter tax from Lump Sum Distribution Averaging Schedule:
(Attach AR1000TD)
.................................................................... 41
00
42.
IRA and qualified plan withdrawal and overpayment penalties:
(Attach Federal Form 5329, if required)
.................................... 42
00
TOTAL TAX: (Add Lines 39 through 42) ............................................................................................................................ 43
43.
00
44.
Personal Tax credit: (Enter total from Line 7D, page NR1) ....................................................... 44
00
45.
State Political Contributions credit:
(Attach schedule)
.............................................................. 45
00
46.
Other State Tax credit:
[Attach a copy of other state tax return(s)]
............................................. 46
00
47.
Child care credit:
(Attach Fed. Form 2441 or 1040A, Sch. 2, 20% of Federal credit allowed)
...... 47
00
48
Credit for adoption expenses:
(Attach Form 8839)
.................................................................. 48
00
49.
Phenylketonuria Disorder credit:
(See Instructions. Attach AR1113)
......................................... 49
00
50.
Business and Incentive Tax credit:
(Attach schedule and certificate)
......................................... 50
00
TOTAL CREDITS: (Add Lines 44 through 50) .................................................................................................................. 51
51.
00
NET TAX: (Subtract Line 51 from Line 43. If Line 51 is greater than Line 43, enter 0) ........................................................... 52
52.
00
52A. Enter the amount from Line 34, Column C: ..................................................................... 52A
00
52B. Enter the total amount from Line 34, Columns A and B: ................................................ 52B
00
52C. Divide Line 52A by 52B: (See Instructions). ....................................................................................................................... 52C
%
52D. APPORTIONED TAX LIABILITY: (Multiply Line 52 by Line 52C) ......................................................................................... 52D
00
53
Arkansas Income Tax withheld:
(Attach State copies of W-2 Forms)
........................................ 53
00
54.
Estimated tax paid or credit brought forward from last year: ..................................................... 54
00
55.
Payments made with extension: (See Instructions) ................................................................. 55
00
56.
Early childhood program: Certification Number: __________________________________
56
00
(Attach Fed. Form 2441 or 1040A, Sch. 2 & Cert. Form AR1000EC, 20% of Fed. credit allowed)
.
TOTAL PAYMENTS: (Add Lines 53 through 56) .............................................................................................................. 57
57.
00
AMOUNT OF OVERPAYMENT/REFUND: (If Line 57 is greater than Line 52D, enter difference) .................................... 58
58.
00
59.
Amount to be applied to 2004 estimated tax: .......................................................................... 59
00
60.
Amount of Checkoff
Contributions:(Attach Schedule
AR1000-CO). .......................................... 60
00
AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 59 and 60 from Line 58) ...................................... REFUND 61
61.
☺
00
AMOUNT DUE: (If Line 57 is less than Line 52D, enter difference; If over $1,000, see instructions) ..................... TAX DUE 62
62.
00
62A.
Attach Form AR2210:
Enter Exception in box 62A
Penalty 62B
00
62C. Please attach your check or money order, made out to “Dept. of Finance and Administration”, for the tax and
penalty (if applicable) due. Be sure to write your Social Security Number on your check: ............................... TOTAL DUE 62C
00
63.
Source of income not subject to Arkansas tax: (Memorandum only)
PLEASE SIGN HERE:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and
statements, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer)
is based on all information of which preparer has any knowledge.
Your Signature
Occupation
Date
May the Arkansas Revenue
Agency discuss this return with
the preparer shown below?
Spouse’s Signature
Occupation
Date
Yes
No
For Department Use Only
ID Number/Social Security Number
Paid Preparer’s Signature
A
Preparer’s Name
City/State/Zip
B
C
Address
Telephone Number
D
Mail REFUND returns to:
DFA State Income Tax, P. O. Box 1000, Little Rock, AR 72203-1000.
E
Mailing Information
Mail TAX DUE returns to:
DFA State Income Tax, P. O. Box 2144, Little Rock, AR 72203-2144.
Mail NO TAX DUE returns to: DFA State Income Tax, P. O. Box 8026, Little Rock, AR 72203-8026.
F
Please Note: NEW DUE DATE IS APRIL 15, 2004
Page NR2 (R 11/03)
CLICK HERE TO CLEAR FORM

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