Form Ar1000adj - Schedule Of Other Adjustments - 2012
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AR1000ADJ
2012
ITAD121
ARKANSAS INDIVIDUAL INCOME TAX
SCHEDULE OF OTHER ADJUSTMENTS
Social Security Number
Name
INSTRUCTIONS
Full Year Resident Filers - Complete columns (A) and (B) if using filing status 4 (married filing separately on the same return). All other
filing statuses must complete column (A) only.
Part Year Resident Filers - Complete columns (A) and (B), if using filing status 4 (married filing separately on the same return). All
other filing statuses must complete column (A) only.
Enter only the amount of adjustments attributable to Arkansas in column (C).
Full Year Nonresident Filers - Complete columns (A) and (B), if using filing status 4 (married filing separately on the same return). All
other filing statuses must complete column (A) only.
If an amount is entered in column (C), attach explanation.
Enter the total of each column on Line 15 of this form and on Line 23 of AR1000F or AR1000NR.
See instructions on the reverse side of this form.
(B)
Spouse’s
(C) Arkansas
(A) Your/Joint
Adjustments
Adjustments
Adjustments
Status 4 Only
Only
00
00
00
1. Border city exemption: (Attach Form AR-TX) .......................................................................1
00
00
00
2. Arkansas Tax Deferred Tuition Savings Program: (See Instructions) ...................................2
00
00
00
00
3. Payments to IRA: (See Instructions) ....................................................................................3
00
00
00
4. Payments to MSA: (See Instructions) ..................................................................................4
00
00
00
5. Payments to HSA: (See Instructions)...................................................................................5
00
00
00
6. Deduction for interest paid on student loans: (See Instructions)..........................................6
00
00
00
7. Contributions to Intergenerational Trust: (See Instructions) .................................................7
00
00
00
8. Moving expenses:
(Attach federal Form 3903)
....................................................................8
00
00
00
9. Self-employed health insurance deduction: (See Instructions) ............................................9
00
00
00
10. KEOGH, Self-employed SEP and Simple Plans: ...............................................................10
00
00
00
11. Forfeited interest penalty for premature withdrawal: .......................................................... 11
00
00
00
12. Alimony/Sep. Maint. paid to: Name: _____________________ SSN: _______________ 12
00
00
00
13. Support for individuals with permanent disabilities:
(Attach Form AR1000DC)
.................13
00
00
00
14. Organ Donor Deduction:
(Attach Form AR1000OD)
..........................................................14
00
00
00
15. TOTAL OTHER ADJUSTMENTS: (Enter here and on AR1000F/AR1000NR, Line 23) ..... 15
NOTE:
Do not enter amounts from categories that are not printed on this form. Enter reforestation adjustments, depreciation
differences, etc. on Line 20 of Form AR1000F/AR1000NR. See instructions for additional information.
ATTACH AS THE SECOND PAGE OF YOUR RETURN
AR1000ADJ (R 8/22/12)
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