Form Ar1000adj - Schedule Of Other Adjustments - 2005
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1AR1000ADJ
2005
STATE OF ARKANSAS
SCHEDULE OF OTHER ADJUSTMENTS
INDIVIDUAL INCOME TAX RETURN
ATTACH AS THE SECOND PAGE OF YOUR RETURN
Name
Social Security Number
INSTRUCTIONS
AR1000 Full Year Resident Filers - Complete column (A) only, if using filing status 1 (single), filing
status 2 (married filing joint), filing status 3 (head of household), filing status 5 (married filing separately on
different returns) or filing status 6 (qualifying widow or widower). Complete columns (A) and (B) only, if
using filing status 4 (married filing separately on the same return).
AR1000NR Nonresident or Part-Year Resident Filers - Complete column (A) and (C) only, if
using filing status 1 (single), filing status 2 (married filing joint), filing status 3 (head of household), filing
status 5 (married filing separately on different returns) or filing status 6 (qualifying widow or widower).
Complete columns (A), (B) and (C) if using filing status 4 (married filing separately on the same return).
Total each column, if required, and enter the totals on Line 14 of this form and on Line 25 of page AR1/
NR1 of Form AR1000/AR1000NR.
See line by line instructions on the reverse side of this form.
(A) Your/Total
(B)
Spouse’s
(C) Arkansas
Adjustments
Adjustments
Adjustments
Status 4 Only
Only
00
00
00
1. Payments to IRA: (See Instructions) ....................................................................................... 1
00
00
00
2. Payments to MSA: (See Instructions) ...................................................................................... 2
00
00
00
3. Payments to HSA: (See Instructions) ...................................................................................... 3
00
00
00
4. Deduction for interest paid on student loans:(See Instructions) ................................................. 4
00
00
00
5. Contributions to Intergenerational Trust: (See Instructions) ....................................................... 5
00
00
00
6. Moving expenses:
(Attach Federal Form 3903)
........................................................................ 6
00
00
00
7. Self-employed health insurance deduction: (See Instructions) .................................................. 7
00
00
00
8. KEOGH, Self-employed SEP and Simple Plans: ..................................................................... 8
00
00
00
9. Forfeited interest penalty for premature withdrawal: .................................................................. 9
00
00
00
10. Alimony/Sep. Maint. paid to: Name: ______________________ SSN: _______________ 10
00
00
00
11. Support for permanently disabled individual:
(Attach Form AR1000DC)
.................................. 11
00
00
00
12. Organ Donor Deduction:
(Attach Form AR1000OD) ...............................................................
12
00
00
00
13. Arkansas Tax Deferred Tuition Savings Program: .................................................................. 13
00
00
00
14. TOTAL OTHER ADJUSTMENTS: Enter here and on page AR1/NR1, Line 25 ........................ 14
AR1000ADJ (R 11/05)
CLICK HERE TO CLEAR FORM
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