Annual Corporation Franchise Tax Report 2012 (Non-Stock Corporation) Form
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1Mark Martin
123456789
, Arkansas Secretary of State
ANNUAL CORPORATION FRANCHISE TAX REPORT 2012
(Non-Stock Corporation)
For the year ending 12/31/2011
Reports and taxes are due on or before May 1, 2012. Penalty and interest will be due for reports if the United States Postal Service’s
postmark is after the deadline. Complete this report online at , or sign in ink and mail to the address
listed below.
1.
Save Time & File Online
Anytime Day Or Night At
2.
6.
Date of Qualification: _______________________________
Correct any information, if needed, in space provided below:
State of Incorporation: ______________________________
Tax Contact Name:
Nature of Business: ________________________________
Address:
Address Line 2:
City, State, Zip:
Phone # of Tax Contact:
E-mail Address:
Required Information:
Federal Tax ID#:
3.
___ A
4, 5 & 6
LL OF THE INFORMATION IN SECTIONS
HAS
BEEN VERIFIED AND HAS BEEN FOUND TO BE EXACTLY
’
.
THE SAME AS LAST YEAR
S REPORT
4.
Registered Agent Information:
Name:
Address 1:
Address 2:
City, State, Zip:
Principal Office Information:
Address:
City, State Zip:
5.
Current Names of Corporate Governors:
President: ______________________________________
Vice-President: __________________________________
Secretary: ______________________________________
Treasurer: ______________________________________
Controller: ______________________________________
Tax Preparer: ____________________________________
C
W
A
S
P
$300.00
T
D
$300.00
ORPORATIONS
ITHOUT
UTHORIZED
TOCK
AY
OTAL
UE
I declare, under the penalties of perjury, that the foregoing statements are true to the best of my knowledge and belief.
Executed this _________ day of __________________, ____________
(Day)
(Month)
(Year)
Print Name________________________________________
Signature________________________________________
Must be printed in ink by: Pres., Sec., Vice-Pres., Treasurer, or Tax Preparer
Must be signed in ink by: Pres., Sec., Vice-Pres., Treasurer, or Tax Preparer
Due on or before May 1, 2012 – Penalty and interest due after May 1, 2012
You may file this electronically over the internet at
Remittance must accompany this report • Make checks payable to Arkansas Secretary of State
Phone 501-682-3409 or 888-233-0325 (Toll Free)
Mail to: Business and Commercial Services Division • P.O. Box 8014 • Little Rock, Arkansas 72203-8014
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