Form Ar1000-Co - Schedule Of Check-Off Contributions - 2006
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1AR1000-CO
2006
ARKANSAS INDIVIDUAL INCOME TAX
SCHEDULE OF CHECK-OFF CONTRIBUTIONS
NAME _________________________________________________________________ SSN ______________________
SPOUSE’S NAME ________________________________________________________ SSN ______________________
ADDRESS ________________________________________________________________________________________
CITY _______________________________________________________ STATE __________________ZIP __________
INSTRUCTIONS: Check the appropriate box and enter the designated amount for each check-off contributions in the box provided.
Total your contributions and enter the amount in Box 8. Contributions are limited to whole dollar amounts only.
FOR TAXPAYERS WHO ARE DUE A REFUND: This schedule must be attached to any return claiming a check-off
contribution. Enter the amount in Box 8 on Line 52 of the AR1000/AR1000NR or Line 24 of the AR1000S. The total amount
you contribute will reduce your refund by a corresponding amount. If this schedule is not attached to your AR1000/AR1000NR/
AR1000S or if the amount in Box 8 is not entered on Line 52 of the AR1000/AR1000NR or Line 24 of the AR1000S, your
contribution will not be recognized and the amount will be refunded to you.
FOR TAXPAYERS WHO OWE ADDITIONAL TAXES: Detach this schedule and submit a separate check for the total
amount of your check-off contributions. Mail to: Arkansas Individual Income Tax - Accounting Branch, P.O. Box 3628, Little
Rock, AR 72203.
1. ARKANSAS DISASTER RELIEF PROGRAM ..........................................................CLS 1162
$
[
] $1
[
] $5
[
] $10 [
] $20 [
] ____________
[
] Your Total Refund
Enter Amount
2. U.S. OLYMPIC COMMITTEE PROGRAM ............................................................... CLS 1145
$
[
] $1
[
] $5
[
] $10
[
] ____________
[
] Your Total Refund
Enter Amount
3. ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF ..................CLS 1164
$
[
] $1
[
] $5
[
] $10
[
] ____________
[
] Your Total Refund
Enter Amount
4. BABY SHARON’S CHILDREN’S CATASTROPHIC ILLNESS PROGRAM ........CLS 1144
$
[
] $1
[
] $5
[
] $10 [
] $20 [
] ____________
[
] Your Total Refund
Enter Amount
5. ORGAN DONOR AWARENESS EDUCATION PROGRAM ...................................CLS 1146
$
[
] $1
[
] $5
[
] $10
[
] ____________
[
] Your Total Refund
Enter Amount
6. AREA AGENCIES ON AGING PROGRAM ...............................................................CLS 1149
$
[
] $1
[
] $5
[
] $10
[
] ____________
[
] Your Total Refund
Enter Amount
7. MILITARY FAMILY RELIEF PROGRAM ...................................................................CLS 1147
$
[
] $1
[
] $5
[
] $10 [
] $20 [
] ____________
[
] Your Total Refund
Enter Amount
8. TOTAL CHECK-OFF CONTRIBUTION .......................................................................................... $
AR1000-CO (R 09/06)
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