Form Ar1103 - Supplemental Shareholder'S Consent Form

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STATE OF ARKANSAS
Election By Small Business Corporations
AR1103 Supplemental Shareholder’s Consent Form
Name of Corporation
Federal Employer Identification Number (FEIN)
Name, Address, City, State and Zip
Shareholder’s signature. For this election
code of each Shareholder.
to be valid, all shareholders must signify
Shareholder Information
(Please type or print)
consent by signing below.
Social Security Number of
Shareholder or FEIN
Do Not write in shaded areas
Signature
Date
NOTE: Attach this supplemental consent form to the original AR1103 Election By Small Business Corporation form.
Mail completed Form to: Corporation Income Tax Section, P.O.Box 919, Little Rock, AR
72203-0919
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