Form Ar1100-Co - Schedule Of Check-Off Contributions Corporation Income Tax Return
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AR1100-CO
STATE OF ARKANSAS
SCHEDULE OF CHECK-OFF CONTRIBUTIONS
CORPORATION INCOME TAX RETURN
ATTACH IMMEDIATELY AFTER SCHEDULE A OF ARKANSAS FORM AR1100CT
NAME ____________________________________________________ FEIN __________________________
ADDRESS ________________________________________________________________________________
CITY _____________________________________________________ STATE __________ ZIP ___________
INSTRUCTIONS: Check the appropriate box and then enter the designated amount for each check-off in the box provided.
Total your contributions and enter the amount in Box I.
CONTRIBUTIONS ARE LIMITED TO WHOLE DOLLAR AMOUNTS ONLY.
FOR TAXPAYERS THAT ARE DUE A REFUND: This schedule must be attached to any return claiming a check-off contribution. Enter
the amount from Box I (Total Check Off Contribution) from this schedule on Line 41 of the AR1100CT. The total amount you contribute will
reduce your refund by a corresponding amount. If this schedule is not attached to your AR1100CT or if the amount in Box I is not entered
on Line 41 of the AR1100CT, then your contribution will not be recognized and the amount will be refunded to you.
FOR TAXPAYERS THAT OWE ADDITIONAL TAXES
:
Detach this schedule and submit a separate check for the amount of
your check-off contributions. Mail to: Arkansas Corporation Income Tax, P O Box 919, Little Rock, AR 72203-0919
A. ARKANSAS DISASTER RELIEF PROGRAM.
..................................................................... CLS 1162
$
[
] $1
[
] $5 [
] $10 [
] $20
[
] _____________
[
] Your Total Refund
Write in Amount
B. U.S. OLYMPIC COMMITTEE PROGRAM. ............................................................................... CLS 1145
$
[
] $1
[
] $5
[
] $10
[
] _____________
[
] Your Total Refund
Write in Amount
C. ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF. ................................. CLS 1164
$
[
] $1
[
] $5
[
] $10
[
] _____________
[
] Your Total Refund
Write in Amount
D. BABY SHARON’S CHILDREN’S CATASTROPHIC ILLNESS PROGRAM. ....................... CLS 1144
$
[
] $1
[
] $5 [
] $10
[
]$20
[
] _____________
[
] Your Total Refund
Write in Amount
E. ORGAN DONOR AWARENESS EDUCATION PROGRAM. ................................................... CLS 1146
$
[
] $1
[
] $5
[
] $10
[
] _____________
[
] Your Total Refund
Write in Amount
F. MILITARY FAMILY RELIEF PROGRAM. ................................................................................... CLS 1147
$
_________
[
] $1
[
] $5 [
] $10
[
] $20
[
]
[
] Your Total Refund
Write in Amount
G. AREA AGENCIES ON AGING PROGRAM.. ............................................................................. CLS 1149
$
[
] $1
[
] $5
[
] $10
[
] _____________
[
] Your Total Refund
Write in Amount
H. NEWBORN UMBILICAL CORD BLOOD INITIATIVE. ................................................................................CLS 1180
$
[
] $1
[
] $5 [
] $10 [
]$20
[
] _____________
[
] Your Total Refund
Write in Amount
I. TOTAL CHECK OFF CONTRIBUTION. ...........................................................................................................
$
AR1100CO (R 6/2013)
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