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AR8453-C

2011

ARKANSAS

CORPORATION INCOME TAX

DECLARATION FOR ELECTRONIC FILING

For calendar year 2011, or tax year beginning

, 20

, ending

, 20

Federal Employer Identification Number

Name of Company

PART 1

TAX RETURN INFORMATION (Whole Dollars Only)

Total Income (Form AR1100CT, Line 17) ..................................................................................................................

Net Taxable Income (Form AR1100CT, Line 32). .....................................................................................................

Total Tax Liability (Form AR1100CT, Line 35). .........................................................................................................

Overpayment (Form AR1100CT, Line 39) .................................................................................................................

Tax Due (Form AR1100CT, Line 43). ........................................................................................................................

PART 2

DECLARATION OF OFFICER (Sign only after Part I is completed)

If the corporation is filing a balance due return, I understand that if the State of Arkansas does not receive full and timely payment of its tax liability, The

corporation will remain liable for the tax liability and all applicable interest and penalties. If the federal corporate return is rejected, I understand the state

corporate return may also be rejected.

Under penalties of perjury, I declare that I am an officer of the above corporation and that the information I have given my electronic return originator (ERO),

transmitter, and/or intermediate service provider (ISP) and the amounts in Part I above agree with the amounts on the corresponding lines of the corpora-

tion’s 2011 Arkansas income tax return. To the best of my knowledge and belief, the corporation’s return is true, correct, and complete. I consent to my

ERO, transmitter, and/or ISP sending the corporation’s return, this declaration, and accompanying schedules and statements to the State of Arkansas. I

also consent to the State of Arkansas sending my ERO, transmitter, and/or ISP an acknowledgment of receipt of transmission and an indication of whether

or not the corporation’s return is accepted, and, if rejected, the reason(s) for the rejection. If the processing of the corporation’s return or refund is delayed,

I authorize the State of Arkansas to disclose to my ERO, transmitter, and/or ISP the reason(s) for the delay, or when the refund was sent.

Sign

Here

Signature of officer

Date

Title

PART 3

DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER

I declare that I have reviewed the above corporation return and that the entries on Form AR8453-C are complete and correct to the best of my knowledge.

If I am only a collector, I understand that I am not responsible for reviewing the corporation’s return; I declare that Form AR8453-C accurately reflects the

data on the return. I have obtained the officer’s signature on Form AR8453-C before submitting this return to the State of Arkansas, and have provided the

officer with a copy of all forms and information to be filed with the State of Arkansas. If I am also the Paid Preparer, under penalties of perjury I declare that

I have examined the above corporations return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true,

correct and complete. This declaration of Paid Preparer is based on all information of which the preparer has knowledge..

ERO’s

Check if also

ERO’s SSN or PTIN

Date

Check if

ERO’S

paid preparer

signature

self-employed

Use