AR1023CT
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STATE OF ARKANSAS
CORPORATION INCOME TAX SECTION
Application for Income Tax Exempt Status
PART I
Identification of Applicant
1a Full Name of Organization (As shown in organizing document)
2 FEIN
1b C/O Name (if applicable)
3 Name and telephone number of person to be
contacted if additional information is needed.
1c Address (Number, Street and Room or Suite Number
(
)
1d City or Town, State and ZIP Code
4 Tax Year (Month/Year)
5 Date Incorporated or Formed
6 Activity Codes (See Instructions)
7 Arkansas Code Section applying under
8 Date began activity in Arkansas
9 Domestic or Foreign
10 IRC Exempt Under
11 IRS Approval Date
12 IRS Expiration Date
13 Has the organization filed Arkansas Corporation Income Tax Returns? ................................................................................................
Yes
No
(If “Yes”, state the tax years filed)
14 Check the box for your type of organization.
BE SURE TO ATTACH A COMPLETE COPY OF THE CORRESPONDING DOCUMENTS TO THE APPLICATION BEFORE MAILING.
01
Corporation:
Attach a copy of your Articles of Incorporation (including amendments and restatements) showing approval by the appropriate
State official; also include a copy of your Bylaws.
02
Trust:
Attach a copy of your Trust Indenture or Agreement, including all appropriate signatures and dates.
03
Cooperative:
Attach a copy of your creating documents and a copy of your Bylaws, Rules and Regulations.
04
Partnership:
Attach a copy of your Partnership Agreement and Bylaws if any.
05
Association:
Attach a copy of your Articles of Association, Constitution, or other creating documents, with a declaration or other evidence the
organization was formed by adoption of the document by more than one person; also include a copy of your Bylaws.
If you are a corporation or an unincorporated association that has not yet adopted Bylaws, check here .................................................................
I declare under the penalties of perjury that I am authorized to sign this application on behalf of the organization and that I have examined this applica-
tion, including the accompanying schedules and attachments, and to the best of my knowledge, it is true, correct and complete.
Please
Sign
Here
Title or Authority Signer
Signature
Date
Please mail to the following address
Corporation Income Tax, P O Box 919, Little Rock, AR 72203
AR1023CT (11/16/2012)
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