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STATE OF ARKANSAS
AR1100ESCT
Extension Corporation Income Tax Payment
Voucher
(R 9/7/2011)
AIRS
5
Tax Year Ending __________________
(MM/DD/YYYY)
Federal Employer Identification
Number
Due Date
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Name of
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Corporation
Amount
Address
$
of this
Payment
City, State, Zip
Enter Whole Dollars
Telephone #
(ex. 1,234,567.00)
CITEIN0000000000012312012EXTPYM00000000000000000000000