Arkansas State Tax Withholding Form
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1Arkansas Local Police and Fire Retirement System
rd
620 W. 3
, Suite 200
Little Rock, AR 72201-2223
State Tax Withholding Form
Please remember changes can be made through the Member Portal at
Instructions
Pursuant to Act 27 of 1989, only the first $6,000 received in employer-sponsored pension plan
payments is exempt from Arkansas state tax. Please properly complete and return this form to
LOPFI.
LOPFI can withhold and remit your tax withholding each month to the Department of Finance &
Administration. Please indicate your preference on the withholding certificate below.
NOTE: Explanation of Options 2 & 3 below are as follows:
Option 2:
Withholding will be computed using a table that excludes $6,000 from the amount you
receive from LOPFI. If this option is selected, please check “Married” or “Single” and
indicate the number of dependents.
Option 3:
Withholding will be a fixed amount that you determine.
__________________________________________________________________________________
State of Arkansas
Arkansas Local Police & Fire Retirement System
Special Withholding Certificate
PLEASE PRINT:
1) Name (First, Middle, Last)
_____________________________________________
2) Social Security Number
_____________________________________________
3) Mailing Address
_____________________________________________
_____________________________________________
Please check box:
1.
Do not withhold any State income tax from my annuity (do not check any other boxes)
2.
Withhold Arkansas Income Tax using the STANDARD TAX TABLES
Single
Married
Number of Dependents _____ (Do not include yourself or your spouse)
3.
Withhold $__________ Arkansas Income Tax per month from my annuity payment
Signature ________________________________
Date _______________________
DC138 1-2014
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