Arkansas 2016

Individual Income Tax

Forms and Instructions

Long Booklet Full Year Resident Part Year Resident

Nonresident

vf Simple Reasons to e-file! Faster Refunds: With Direct Deposit Direct Debit Payments

Filing Confirmation Provided

If You Qualify, It’s Free

Makes Complex Returns Easy

File Federal & State Forms Together

$4490 908

Secure

ATAP

Arkansas Taxpayer Access Point (ATAP) allows taxpayers or their representatives to log on to a secure site and manage their account online.

You can access ATAP at www.atap.arkansas. gov to:

@ Make name and address changes e@ View account letters

@ Make payments

@ Check refund status

(Registration is not required to make payments or to check refund status.)

Pay tax by credit card (Vendor charges nominal fee)

www.officialpayments.com or call (800) 272-9829

Governor Asa Hutchinson

Free File Alliance:

As a member of the “Free File Alliance”, the State of Arkansas offers certain taxpayers the opportunity to electronically file their return with no fee. If you meet the specified criteria (including income, military service, or eligibility for federal Earned Income Tax Credit) you may be eligible for this program.

For details go to: www.dfa.arkansas.gov/offices/incometax/efile

Where’s My Refund?

Check your refund status at www.atap.arkansas.gov

Identity Theft has been a growing problem nationally and the Department is taking additional measures to ensure tax refunds are issued to the

correct individuals. These additional measures may result in tax refunds not being issued as quickly as in past years.

For your questions/comments: Manager, Individual Income Tax

P. O. Box 3628

Little Rock, AR 72203-3628

efile)

TAX HELP AND FORMS

Internet

You can access the Department of Finance and Administration’s website at www.dfa.arkansas.gov.

@ Check the status of your refund

@ Get current and prior year forms and instructions

e@ Access latest income tax info and archived news

@ Get e-file information

You can e-mail questions to:

individual.income@dfa.arkansas.gov

_ ww, J 44 Phone Individual Income Tax Hotline... (601) 682-1100

or (800) 882-9275

Representatives are available to assist callers at the numbers above during normal business hours (Monday through Friday from 8:00 a.m. to 4:30 p.m.) with:

@ Notices Received @ Amended Returns @ Payment Information

@ Taxpayer Assistance e@ Forms e@ Audit and Examination

For hearing impaired access, call (800) 285-1131 using a Text Telephone Device (for Spanish, call (866) 656-1842).

Other useful phone numbers: Business Incentive Credits .. Withholding Tax Collections Revenue Legal Counsel Corporate Income Tax Sales and Use Tax...... Problem Resolution and...

Tax Information Office ('

.... (501) 682-7106 .... (501) 682-7290 .... (501) 682-5000 _ (501) 682-7030

(

(

(

. (501) 682-4775 . (501) 682-7104

... (501) 682-7751 ‘ers In Compromise)

Internal Revenue Service............... (800) 829-1040 Social Security Administration ........ (800) 772-1213

ED Forms

To obtain a booklet or forms you may:

1. Access our website at: www.dfa.arkansas.gov/offices/ incometax/individual

2. Visit your county revenue office 3. Visit your local library or

4. Call the Individual Income Tax Hotline (501) 682-1100 or (800) 882-9275

Page 2

ATAP

Arkansas Taxpayer Access Point (ATAP) allows taxpayers or their representatives to log on to a secure site and manage their ac- count online.

You can access ATAP at www.atap.arkansas.gov to:

@ Make name and address changes

e@ View account letters

@ Make payments

@ Check refund status

(Registration is not required to make payments or to check refund status.)

GP mai

Choose the appropriate address below to mail your return:

TAX DUE RETURN: Arkansas State Income Tax P.O. Box 2144 Little Rock, AR 72203-2144

REFUND RETURN: Arkansas State Income Tax P.O. Box 1000 Little Rock, AR 72203-1000

NO TAX DUE/REFUND RETURN: Arkansas State Income Tax P.O. Box 8026 Little Rock, AR 72203-8026

Be sure to apply sufficient postage or your return will not be delivered by the U.S. Postal Service.

Walk-In

Representatives are available to assist walk-in taxpayers with income tax questions, but are not available to prepare your return.

No appointment is necessary, but plan to arrive before 4:00 p.m. to allow sufficient time for assistance.

The Individual Income Tax Office is located in Room 2300, Ledbetter Building, at 1816 W. 7th Street in Little Rock.

Office hours are Monday through Friday from 8:00 a.m. to 4:30 p.m.

CONTENTS

Tax Help and Forms

Electronic Filing

Special Information for 2016

If the IRS Audits You

Information Exchange Programs with the IRS Identity Theft

Preservation of Tax Records

Request Copies of Arkansas Tax Returns Military Personnel

Definitions

Instructions

Form Inserts:

AR1000F AR1000NR

AR3

AR4

AR1000ADJ AR1000D AR1000TC AR1000-CO Consumer Use Voter Registration

Instructions (continued)

Instructions for Form AR3, Itemized Deduction Schedule Student Loan Interest Worksheet

IRA Phase Out Chart

Self-Employed Health Insurance Deduction Worksheet Mileage and Depletion Allowances

Depreciation Information

How to Fill Out Your Check

For Taxpayers’ Information

Taxpayer Bill of Rights

Low Income Tax Tables

Regular Tax Table

Index to Instructions

Before Mailing Your Return Checklist

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ELECTRONIC FILING

www.arkansas.govlefile

E-file is hassle-free—both your federal and Arkansas income tax returns can be filed electronically in one transmission.

E-file is smart—computer programs catch 98% of tax return errors.

E-file is worry-free-receive acknowledgement within 2 to 3 business days if your return has been received and accepted.

Arkansas participates in the Federal/State Electronic Filing Program for Individual Income Tax. The program is available to most full year residents and certain qualifying nonresidents and part year residents.

Since Arkansas is a member of the “Free File Alliance,” depending on the level of income, taxpayers may qualify to file returns for free. (Go to www.dfa.arkansas. gov/offices/incometax/efile for details.)

Over 150,000 taxpayers took advantage of online filing last year. The same advantages are obtained by online filing as by electronic filing, but it does not require a preparer. For a nominal fee your federal and state returns can be prepared and filed electronically.

The State of Arkansas is requesting additional information this filing season in an effort to combat identity tax fraud and ensure that your hard-earned tax refund goes to you. Providing information from your driver’s license or state-issued identification card will help protect your identity and could help process your return quicker. However, this is only a request. Information from your driver’s license is not required, and your return will be processed without the additional information. The information is being requested solely to help protect your identity and ensure a more-secure refund.

PAY BY CREDIT CARD

(Vendor charges nominal fee)

yeRTCHA L, PAYMENTS Core, € a

im S

www.officialpayments.com or call (800) 272-9829

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SPECIAL INFORMATION FOR TAX YEAR 2016

Capital Gains Exemption (Act 1173 of 2015): For tax year 2016, the exemption has been increased: For gains realized from January 1, 2016 to June 30, 2016, 45% of net capital gains are exempt from tax. For gains realized from July 1, 2016 to December 31, 2016, 50% of net capital gains are exempt from tax.

For tax year 2014 and forward, 100% of net capital gains in excess of $10,000,000 are exempt from tax.

Tax Brackets Adjusted (Act 22 of 2015): For tax year 2016, the tax brackets have been adjusted due to rate changes based upon income.

Opt Out Box Added: Beginning with tax year 2016, a box has been added to allow you to opt out of receiving a tax booklet for the following year.

ARDD Direct Deposit Form Removed: Beginning with tax year 2016, the ARDD direct deposit form is no longer available for direct deposit requests. The direct deposit information is now included on Forms AR1000S, AR1000F and AR1000NR.

Additional Information Requested for e-File: The State of Arkansas is requesting additional information this filing season in an effort to combat identity tax fraud and ensure that your hard-earned tax refund goes to you. Providing information from your driver’s license or state-issued identification card will help protect your identity and could help process your return quicker. However, this is only a request. Information from your driver’s license is not required, and your return will be processed without the additional information. The information is being requested solely to help protect your identity and ensure a more-secure refund.

| J Ifthe Internal Revenue Service examines your return for any tax year and changes your net taxable income, you must report the changes to the Arkansas Department of Finance and Administration within one hundred eighty (180) days from the receipt of the notice and demand for payment by the Internal Revenue Service.

File an Amended Individual Income Tax Return, for the year(s) involved reporting the changes to your state return. Attach a copy of the federal changes.

If you fail to notify this Department within one hundred eighty (180) days and do not file the required amended return, the Statute of Limitations will remain open for three (3) years on the year(s) in question. Additional interest will be figured on any tax you owe the State of Arkansas.

Under authorization of Internal Revenue Code Section 6103(D) the State of Arkansas participates in several information exchange programs with the Internal Revenue Service:

@ CP2000: The IRS matches income reported on a taxpayer’s federal income tax return with documents (W-2s, 1099s, etc.) provided to the IRS by the payer to determine whether income was omitted from the taxpayer’s return. If unreported income is discovered, the IRS assesses additional federal tax on the omitted income then notifies the State of Arkansas. The taxpayer’s state tax return is then reviewed for unreported income. (Some examples of commonly omitted income include wages, pensions, and cancellation of debt.)

@ Revenue Agent Reports “RARs”: When the IRS adjusts a taxpayer’s federal income tax return as the result of an audit, details are provided to the State of Arkansas. The taxpayer’s state tax return is then reviewed and adjusted if appropriate. (Some examples of RAR adjustments include disallowance of deductions, expenses, or dependents and assessment of early withdrawal penalties.)

@ Non-filer Identification: The IRS provides the Arkansas Department of Finance and Administration with a list of taxpayers who filed federal returns using Arkansas addresses. This information is then compared with Arkansas income tax records to identify individuals who filed federal returns using Arkansas addresses but did not file Arkansas returns. Letters are sent inquiring whether the taxpayer is required to file. The taxpayer should file the return in question or provide documentation why he/she is not required to file. If a sufficient response is not received, state tax is assessed using amounts reported on the taxpayer’s federal return, and the taxpayer is mailed a Notice of Proposed Assessment.

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IDENTITY THEFT

In recent years identity theft associated with income tax returns has become an increasingly severe problem. Sometimes thieves steal a taxpayer’s Social Security Number and other private information then use this information to file tax returns and receive refunds that were not due to them.

If you believe your identity may have been used to file an Arkansas state tax return, these are the steps we suggest you take:

>» Contact us at (501) 682-1100 to report that your identity may have been stolen. e Request a hold on your account to stop all fraudulent refunds. >» Contact the IRS Identity Protection Specialized Unit at (800) 908-4490 and inform them that your identity was stolen and may have been used to file a fraudulent tax return.

e You should complete IRS Form 140339, an identity theft affidavit, to support your claim.

>» Send a copy of the stamped IRS identity theft affidavit form to:

Arkansas Individual Income Tax PO Box 3628 Little Rock, AR 72203-3628

» Contact the credit bureaus to ensure there have not been any other thefts related to your identity, and ask to have a fraud alert put on your credit report. The numbers to the credit bureaus are listed below:

e Equifax - (800) 525-6285 e Experian - (888) 397-3742

e Trans-Union - (800) 680-7289

PRESERVATION OF TAX RECORDS

A taxpayer who files an Arkansas income tax return is required to retain records to prove the accuracy of that return. The records must be retained for at least six (6) years (unless otherwise provided by law) and are subject to examination by the Director at any reasonable time during that period.

When a taxpayer fails to preserve and maintain the required records, the director may make an estimated assessment based upon any available information as to the amount of tax due by the taxpayer. Per ACA 26-18-506, the burden of proof of refuting this estimated assessment is upon the taxpayer.

REQUEST FOR COPIES OF ARKANSAS TAX RETURNS

If your tax return was completed by a paid tax preparer, he/she should be able to provide a copy of the return. If you used a software product to prepare your tax return, you should be able to print a copy of the tax return from the software used. Otherwise to request a copy of your Arkansas tax return, please complete and submit Form AR4506. Form AR4506 may be downloaded from our website at: www.arkansas.gov/incometax.

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a= MILITARY PERSONNEL

Military Pay Exemption (Act 1408 of 2013)

Creates a 100% exemption from income tax for service pay or allowance received by an active duty member of the armed forces for tax years beginning on or after January 1, 2014. Active duty includes all members of the armed forces, including the National Guard and Reserve Units.

Military Spouses Residency Relief Act

Exempts a military spouse’s income from Arkansas tax if the servicemember’s Home of Record is not Arkansas and the spouse’s domicile is the same as the service member’s Home of Record. Effective January 1, 2009. Write the words “military spouse” at top of tax return and attach a completed Form AR-MS (available at www.dfa.arkansas.gov/offices/ incometax/individual) and a copy of service member’s Leave and Earning Statement (LES) to verify Home of Record. (For future tax purposes, the nonmilitary spouse must submit a new payroll withholding form, ARW-4MS to his/her employer each year to exempt future withholding.)

The Military Family Tax Relief Act of 2003 (Act 372 of 2009)

This act adopts IRC 121, 134, and 162 as in effect on January 1, 2009. Provisions of this act include exclusion of gain on sale of principal residence, deduction of overnight travel expenses for National Guard and Reserve members, and exclusion from income of “qualified military benefits”.

The Servicemembers Civil Relief Act

Deferral of Tax - Upon notice to the Internal Revenue Service or the tax authority of a state or a political subdivision of a state, the collection of income tax on the income of a servicemember falling due before or during military service shall be deferred for a period not more than 180 days after termination of or release from military service, if a service member’s ability to pay such income tax is materially affected by military service.

Accrual of Interest or Penalty - No interest or penalty shall accrue for the period of deferment by reason of nonpayment on any amount of tax deferred under this section.

Statute of Limitations - The running of a statute of limitations against the collection of tax deferred under this section, by seizure or otherwise, shall be suspended for the period of military service of the servicemember and for an additional period of 270 days thereafter.

Residence or Domicile - A servicemember shall neither lose nor acquire a residence or domicile for purposes of taxation with respect to the person, personal property, or income of the servicemember by reason of being absent or present in any tax jurisdiction of the United States solely in compliance with military orders.

Military Service Compensation - Compensation of a servicemember for military service shall not be deemed to be income for services performed or from sources within a tax jurisdiction of the United States if the servicemember is not a resident or domiciliary of the jurisdiction in which the servicemember is serving in compliance with military orders.

RETIRED MILITARY PERSONNEL

Extension of Time for Veterans (Retirees) to File for Refund (Act 238 of 2009)

This act extends the statute of limitations for a veteran to file a claim for refund of an overpayment that results from retroactive determination by the Secretary of Veterans Affairs that part or all of the uniformed service retirement payments to the taxpayer are payments made for a service-connected disability and are not included in gross income. Effective January 1, 2001.

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DEFINITIONS

GROSS INCOME

Gross income is any and all income (before deductions) other than income specifically described as exempt from tax on pages 9 and 10 “Exempt From Income Tax”.

Exception: The $6,000 exemption on retirement income and the exemption on U.S. active duty military income as described on page 10 are included in gross income.

DOMICILE This is the place you intend to have as your permanent home and the place you intend to return to whenever you are away. You can have only one domicile. Your domicile does not change until you move to a new location which you intend

to make your permanent home. If you move to a new location but intend to stay there only for a limited time (no matter how long), your domicile does not change. This also applies if you are working in a foreign country.

FULL YEAR RESIDENT

You are a full year resident if you lived in Arkansas all of calendar year 2016, or if you have maintained a domicile or Home of Record in Arkansas during the tax year.

NONRESIDENT You are a nonresident if you did not make your domicile in Arkansas.

PART YEAR RESIDENT You are a part year resident if you established a domicile in Arkansas or moved out of the state during calendar year 2016.

MILITARY PERSONNEL

If Arkansas is your Home of Record and you are stationed outside of Arkansas, you are still required to file an AR1000F reporting all of your income, including U.S. active duty military compensation. However, active duty military compensation is exempt from Arkansas tax beginning in tax year 2014. (If you are stationed in Arkansas and your Home of Record is another state, Arkansas does not tax your U.S. active duty military compensation.)

U.S. active duty military compensation includes wages received by members of the Army, Navy, Air Force, Marine Corps, Coast Guard, National Guard, and Reserve Units.

DEPENDENTS

You may claim as a dependent any person who received over half of his or her support from you, earned less than $4,050 in gross income, and was your:

Child Stepchild Mother Father Grandparent Brother Sister Grandchild Stepbrother Stepsister Stepmother Stepfather Mother-In-Law Father-In-Law Brother-In-Law Sister-In-Law Son-In-Law Daughter-In-Law

Or, an individual (other than your spouse) who, for the tax year of the taxpayer, had the same principal place of abode as the taxpayer and was a member of the taxpayer’s household. Or, if related by blood: Uncle, Aunt, Nephew, Niece. The term “dependent” includes a foster child if the child had as his principal place of abode the home of the taxpayer and was a member of the taxpayer’s household for the taxpayer’s entire tax year.

The term “dependent” does not apply to anyone who is a citizen or subject of a foreign country UNLESS that person is a resident of Mexico or Canada.

If your child/stepchild was under age 19 at the end of the year, the $4,050 gross income limitation does not apply. Your child/stepchild may have earned any amount of income and still be your dependent if the other dependency requirements in this section were met.

If your child/stepchild was a student under age 24 at the end of the calendar year, the $4,050 gross income limitation does not apply. The other requirements in this section must be met.

To qualify as a student, your child/stepchild must have been a full-time student for five (5) months during the calendar year at a qualified school, as defined by the Internal Revenue Service.

If your dependent died during the tax year, you may claim the full amount of tax credit for the dependenton your tax return regardless of when the death occurred during the year.

Arkansas has adopted Internal Revenue Code §151(c)(6) regarding the tax treatment of kidnapped children.

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THESE INSTRU

ONS ARE FOR GUIDANCE ON

INSTRUCTIONS

WHO MUST FILE A TAX RETURN

FULL YEAR RESIDENTS (Use Form AR1000F)

Married

Married Filin

Widowed in 2014 or 2015, and not remarried in 2016

If your and your file if GROSS MARITAL STATUS FILING STATUS INCOME* is: is: is atleast Single (Including divorced Single $11,737 and legally separated) Head of Household with 1 or no dependents $16,687 Head of Household with 2 or more dependents $19,892

Married Filing Joint with 1 or no dependents

Married Filing Joint with 2 or more dependents

Qualifying Widow(er) with 1 or no dependents

Qualifying Widow(er) with 2 or more dependents $19,892

$16,687

*Gross income is all income (before deductions) other than income specifi- cally described as exempt on pages 9 and 10 “Exempt From Income Tax.”

Exception: The $6,000 exemption on retirement income and the exemption on military income as described on page 10 are included in gross income.

If your gross income was less than the amount shown in the last column for your filing status, you are not required to file a return. However, you must file a return to claim any refund due.

NONRESIDENTS (Use Form AR1000NR)

Nonresidents who received any taxable income from Arkansas sources must file a return (regardless of marital status, filing status, or amount).

PART YEAR RESIDENTS (Use Form AR1000NR)

Part year residents who received any taxable income while an Arkansas resident must file a return (regardless of marital status, filing status, or amount).

WHEN TO FILE

You can file your calendar year original tax return any time after December 31, 2016, but NO LATER THAN April 15, 2017, (unless an extension has been granted).

If you file a fiscal year tax return, your return is due NO LATER THAN three and one-half (3 *2) months following the close of the income year.

NOTE: The date of the postmark stamped by the U.S. Postal Service is the date you filed your return.

If the due date of your return falls on a Saturday, Sunday, or legal holiday, the return will be considered timely filed if it is postmarked on the next business day.

Statute of Limitations - Refunds. An amended return or claim for refund of an overpayment must be filed by the taxpayer within three (3) years from the time the return was filed or two (2) years from the time the tax was paid, whichever is later.

IF YOU NEED MORE TIME

If you request an extension of time to file your federal income tax return (by filing federal Form 4868 with the IRS) you are entitled to receive the same extension on your Arkansas income tax return. The federal automatic extension extends the deadline to file until October 15".

The Department no longer requires that a copy of federal Form 4868 be attached to your state tax return. When your Arkansas return is complete and ready to file, simply check the box on the face of the return indicating you filed a federal extension.

If you do not file a federal extension, you can file an Arkansas extension using Form AR1055 before the filing due date of April 15". Inability to pay is not a valid reason to request an Arkansas extension. Send your request to:

Individual Income Tax Section ATTN: Extension

P.O. Box 3628

Little Rock, AR 72203-3628

AND DO NOT STATE THE COMPLETE LAW

The maximum extension that will be granted to an individual on an AR1055 is one hundred and eighty (180) days, extending the due date until October 15".

NOTE:

When you file your return, check the box indicating you filed a state extension. If the box on the front of your return is not checked, you will not receive credit for your federal or state extension.

An extension extends the amount of time to file your return, but does not extend the amount of time to pay. Any tax due must be paid by April 15, 2017 to avoid failure to pay penalty and interest.

Payments made on extension should be made on Form AR1000ES, Voucher 5.

See Page 15 for information on penalties and interest.

EXEMPT FROM INCOME TAX NOTE: List exempt income on AR4, Part III and include the total on AR1000F/AR1000NR, Line 51. (You do not need to list exclusion amounts from numbers 10-12.)

1. Money you received from a life insurance policy because of the death of the person who was insured is exempt from tax.

NOTE: You must include as taxable income any

interest payments made to you from the

insurer (the insurance company that issued the policy).

2. Money you received from life insurance, an endowment, or a private annuity contract for which you paid the premiums is allowed cost recovery pursuant to Internal Revenue Code §72.

3. Amounts you received as child support payments are exempt from tax.

4. Gifts, inheritances, bequests, or devises are exempt from tax.

5. Scholarships, fellowships, and grants are taxed pursuant to Internal Revenue Code §117. (Stipends are taxed in their entirety.) For additional information on scholarships, fellowships, and grants see instructions for Line 20 on Page 13.

Page 9

6. Interest you received from direct United States obligations, its possessions, the State of Arkansas, or any political subdivision of the State of Arkansas is exempt from tax. Obligations include bonds and other evidence of debt issued pursuant to a government unit’s borrowing power. (Interest received on tax refunds is not exempt income, because it did not result from a debt issued by the United States, the State of Arkansas, or any political subdivision of the State of Arkansas.) Interest from government securities paid to individuals through a mutual fund is exempt from tax.

7. Social Security benefits, VA benefits, Workers’ Compensation, Unemployment Compensation, Railroad Retirement benefits and related supplemental benefits are exempt from tax.

8. The rental value of a home or the housing allowance paid to a duly ordained or licensed minister of a recognized church is exempt to the extent that it was used to rent or provide a home. The rental value of a home furnished to a minister includes utilities furnished to the minister as part of compensation. The housing allowance paid to a minister includes an allowance for utilities paid to the minister as part of compensation to the extent it was used to furnish utilities in the home.

9. Disability income MAY BE exempt from tax pursuant to Internal Revenue Code §104.

10. Beginning with tax year 2014, U.S. active duty military compensation is exempt from tax. To claim the exemption, you must file a return and report all of the income you received during the year.

11. If you received income from an employer sponsored retirement plan, including disability retirement, that is not exempt under IRC §104, the first $6,000 is exempt from tax. If you contributed after-tax dollars to your plan, you are allowed to recover your cost (investment) in your retirement plan in accordance with Internal Revenue Code §72. Then the first $6,000 of the balance is exempt from tax. (If you received income from military retirement, you may adjust your figures if the payment included Survivor's Benefit Payments. The amount of adjustment must be listed on the income statement, and supporting documentation must be submitted with the return.)

12. If you received a traditional IRA distribution after reaching age fifty- nine and one-half (59 1/2), the first $6,000 is exempt from tax. Your traditional IRA distribution may be adjusted for nondeductible IRA contributions, if any, by completing Federal Form 8606 and attaching it to your Arkansas return. Premature distributions made on account of the participant's death or disability also qualify for the exemption. All other premature

Page 10

distributions or early withdrawals including, but not limited to, those taken for medical expenses, higher education expenses or a first-time home purchase do not qualify for the exemption.

A surviving spouse qualifies for the exemption; however he/she is limited to a single $6,000 exemption.

NOTE: Total exemptions from all plans described under 11 and 12 cannot exceed $6,000 per taxpayer, not including recovery of cost.

Gambling winnings from Arkansas electronic games of skill are not included as income and the 3% withholding is excluded from Line 37. To determine if your gambling winnings are taxable, see instructions for Line 20, Page 13.

FILING AN AMENDED RETURN

If filing an amended return, check the box at the top right corner of Form AR1000F/ AR1000NR/AR1000S. Complete the return, replacing the incorrect entries from your original return with the amended entries. Attach an explanation and supporting documentation for items changed. (Do not file an amended return until after your original return has been processed.)

Amended return needed:

. to make changes or adjustments to your original return

. if the IRS examines your federal return for any tax year and changes your net taxable income (required to file an Arkansas amended return within 180 days of IRS notification)

Amended return NOT needed:

. to correct an address (You must provide a completed Individual Income Tax Account Change Form located on our website at www.dfa.arkansas.gov)

. to correct a Social Security Number (Call (501) 682-1100 or write to Individual Income Tax Section, P.O. Box 3628, Little Rock, AR 72203. You may be asked to provide documentation.)

. if you are notified by the Income Tax Section that there is an error on your original return

. if filing a federal amended return with no impact on your Arkansas income tax return

FILING STATUS

DETERMINE YOUR FILING STATUS

BOX 1. Filing Status 1 (Single)

Check this box if you are SINGLE or UNMARRIED and DO NOT qualify as HEAD OF HOUSEHOLD. (Read the instructions for BOX 3 to determine if you qualify for HEAD OF HOUSEHOLD.)

BOX 2. Filing Status 2 (Married Filing Joint)

Check this box if you were MARRIED and are filing jointly. IF YOU ARE FILING A JOINT RETURN, YOU MUST ADD BOTH SPOUSES’ INCOME TOGETHER. Enter the total amount in column A on Lines 8 through 20 under “Your/Joint Income”.

MARRIED COUPLES—CHOOSING THE BEST FILING STATUS

If you and your spouse had separate incomes, you might save money by figuring your tax separately using one of the following two methods. Use the method that suits you best.

METHOD A. List your income separately under Column A (“Your Income”). List your spouse’s income separately under Column B (“Spouse’s Income”). Figure your tax separately and then add your taxes together. See instructions for Married Filing Separately on the Same Return, Box 4.

If you use Method A, your result will be either a COMBINED REFUND or a COMBINED TAX DUE.

METHOD B. You must file separate individual tax returns. See instructions for Married Filing Separately on Different Returns, Box 5.

If you use Method B, one of you may owe tax and the other may get a refund. The tax due must be paid with the proper tax return and the refund will be due on the other return. YOU MAY NOT OFFSET ONE AGAINST THE OTHER.

BOX 3. Filing Status 3 (Head of House- hold)

To file as Head of Household you must have been unmarried or legally separated on December 31, 2016 and meet either 1 or 2 below. The term “Unmarried” includes certain married persons who lived apart, as discussed at the end of this section.

1. You paid over half the cost of keeping a home for the entire year that was the main home of your parent whom you can claim as a dependent. Your parent did not have to live with you in your home.

OR

2. You paid over half the cost of keeping a home in which you lived, and in which one of the following also lived, for more than six (6) months of the year (temporary absences, such as vacation or school, are counted as time lived in the home):

a. Your unmarried child, grandchild, great-grandchild, adopted child or stepchild. This child did not have to be your dependent, but your foster child must have been your dependent.

b. Your married child, grandchild, adopted child or stepchild. This child must have been your dependent.

c. Any other person whom you could claim as a dependent.

MARRIED PERSONS WHO LIVED APART

Even if you were not divorced or legally separated in 2016, you may be considered unmarried and file as Head of Household. See Internal Revenue Service instructions for Head of Household to determine if you qualify.

BOX 4. Filing Status 4 (Married Filing Separately on the Same Return)

Check this box if you were married and are filing SEPARATELY ON THE SAME TAX RETURN. This method of tax computation may reduce your tax liability if both spouses had income. The result will be either a combined refund or a combined tax due.

IF ONE SPOUSE HAD A TOTAL NEGATIVE INCOME, YOU MUST FILE MARRIED FILING JOINTLY.

BOX 5. Filing Status 5 (Married Filing Separately on Different Returns)

Check this box if you were married and are filing separate tax returns.

BOX 6. Filing Status 6 [Qualifying Widow(er)]

Check this box if you are a QUALIFYING WIDOW(ER).

You are eligible to file as a QUALIFYING WIDOW(ER) if your spouse died in 2014 or 2015 and you meet each of the following tests:

1. You were entitled to file MARRIED FILING JOINTLY or MARRIED FILING SEPARATELY ON THE SAME RETURN with your spouse for the year your spouse died. It does not matter whether you actually filed a joint return.

2. You did not remarry before the end of 2016.

3. You had a child, stepchild, adopted child, or foster child who qualified as your dependent for the year.

4. You paid more than half the cost of keeping a home, which was the main home of that child for the entire year except for temporary absences.

DECEASED TAXPAYER

An Arkansas tax return should be filed for a taxpayer who died during the tax year as if the taxpayer had lived the entire year. The word “DECEASED” should appear after his/her name along with the date of death.

NOTE: Any refund check issued to a deceased taxpayer will be made out to the estate of the deceased taxpayer, i.e. “Estate of John/Jane Doe”. To cash the check, the bank may require documentation such as death certificate, will, or power of attorney.

PERSONAL TAX CREDITS

LINE 7A. Each taxpayer and spouse is entitled to one personal tax credit. You can claim additional personal tax credits if you can answer “Yes” to any of these questions:

ls your filing status Head of Household or

Qualifying Widow(er)?

On January 1, 2017, were you age 65 or over?

On December 31, 2016, were you deaf?

On December 31, 2016, were you blind?

Check the box or boxes that apply to you and/or your spouse. You CANNOT claim any of these credits for your children or dependents.

Blindness is defined as being unable to tell light from darkness, having eyesight in the better eye not exceeding 20/200 with corrective lens, or having a field of vision limited to an angle of 20 degrees.

You can claim the Deaf Credit only if the average loss in speech frequencies (500 to 2000 Hertz) in the better ear is 86 decibels, |.S.O., or worse.

Any taxpayer age 65 or over not claiming a retirement income exemption on Line 17 is eligible for an additional $26 (per taxpayer) tax credit. Check the box(es) marked “65 Special”.

Add the number of boxes you checked on Line 7A. Write the total in the box provided. Multiply the number by $26 and write amount in space provided.

LINE 7B. List the name(s) of your dependent(s), Social Security Numbers, and relationship to you in the space provided. DO NOT INCLUDE YOURSELF AND/OR YOUR SPOUSE. The individual(s) you can claim as dependent(s) are described on Page 8. (Attach schedule if more than 3 dependents.)

Add the number of dependents listed on Line 7B. Write the total in the box provided. Multiply the number by $26 and write that amount in the space provided.

LINE 7C. If one or more of your dependents had developmental disabilities, enter his/her name(s) on the line. Multiply $500 by number of dependents with developmental disabilities. Enter the total. (Individual must qualify for credit. See Form AR1000RC5 to check if eligible.)

NOTE: You must attach Form AR1000RC5 to your return if this is the first year you claim the Credit for Individuals with Developmental Disa ies.

A certified AR1000RC5 must be filed with your tax return every five (5) years. If credit was received on a prior year’s return, do not file another AR1000RCS5 until the Individual Income Tax Section notifies you.

LINE 7D. Total the tax credits from Lines 7A, 7B, and 7C. Enter the total on this line and on Line 32.

INCOME

FULL YEAR RESIDENTS

If your filing status is Married Filing Separately on the Same Return, both Column A and Column B must be used. Write your income in Column Aand your spouse’s income in Column B. For all other filing statuses, write all income in Column A only.

NONRESIDENTS AND PART YEAR RESIDENTS

Complete Column A (and Column B if using Filing Status 4) of the AR1OOONR as if you were a full year resident. List all of your income from all sources for the entire year in these two columns.

List in Column C the total combined income (for both spouses) earned while Arkansas residents and income derived from Arkansas sources.

The total tax must be computed on the income totals in Columns A and B. After all allowable tax credits have been subtracted from the total tax, prorate the remaining balance. See instructions for Lines 36A, 36B, 36C, and 36D on Page 14.

NONRESIDENTS AND PART YEAR RESIDENTS MUST ATTACH A COPY OF YOUR FEDERAL RETURN, OR YOUR ARKANSAS RETURN WILL NOT BE PROCESSED.

Round all amounts to the nearest dollar. (For example, if your Form W-2 shows $10,897.50, round to $10,898. If your Form W-2 shows $10,897.49, round to $10,897.)

Staple the state copy of each of your W-2(s) and 1099-R(s) to the left margin of the front of the return.

LINE 8. Add the wages, salaries, tips, etc. reported on your W-2(s). Enter the total on this line. Attach W-2(s).

Enter U.S. Military Compensation on Line 9A or 9B.

Ministers Income:

If you were a duly ordained or licensed minister, you received a housing allowance from your church, and you do not file a federal Schedule C or C-EZ, enter your gross compensation from the ministry less rental value of your home. The balance is subject to tax. The rental value of your home must be shown on Form AR4, Part Ill. Attach AR4 and W-2(s).

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LINE 9A. Beginning with tax year 2014, all of the service pay or allowance received by an active duty member of the armed services is exempt from Arkansas income tax. If you had U.S. active duty military compensation, enter gross amount in the space provided. Do not enter an amount in Column A. Attach W-2(s).

Filing Status 2 (Married Filing Joint): If you and your spouse both had U.S. active duty military compensation, add both gross amounts together and enter here.

Enter U.S. Military Retirement on Line 17A.

LINE 9B. (Filing Status 4 Only) [f your spouse had U.S. active duty military compensation, enter gross income in the space provided. Do not enter an amount in Column B. Attach W-2(s).

Enter U.S. Military Retirement on Line 17B (filing Status 4 only).

HOME OF RECORD OTHER THAN ARKAN- SAS: If your Home of Record is not Arkansas, do not report to Arkansas your income or your nonresident spouse’s income. Filloutand submit AR- NRMILITARY Form to have a note put on your account that you are not required to file a return.

Your spouse’s income is exempt from Arkansas tax if your Home of Record is not Arkansas and your spouse’s domicile is the same as your Home of Record.

However, if your spouse had Arkansas income tax withheld, he/she will need to file a return to get a refund. Write the words “military spouse” at top of tax return and attach a completed Form AR-MS and a copy of service member’s Leave and Earning Statement (LES) to verify Home of Record.

(For future tax purposes, your nonmilitary spouse must submit a new payroll withholding form, ARW- 4MS to his/her employer each year to exempt withholding.)

LINE 10. If you received interest from bank deposits, notes, mortgages, corporation bonds, savings and loan association deposits, and credit union deposits, enter all interest received or credited to your account during the year. If the total is over $1,500, complete and attach Form AR4.

LINE 11. If you received dividends and other distributions, enter amounts received as dividends from stocks in any corporation. If the total is over $1,500, complete and attach Form AR4.

LINE 12. Enter alimony or separate maintenance received as the result of a court order.

LINE 13. If you had business or professional income and filed a federal Schedule C or C-EZ, enter the total dollar amount(s) of net income (or loss) from your federal Schedule C or C-EZ. If you did not file a federal Schedule C or C-EZ, submit a similar schedule and enter the net

Page 12

income (or loss).

If you filed a federal Schedule C or C-EZ, attach it to your return.

Business income may not be split between you and your spouse unless a partnership was legally established. Report partnership income on Form AR1050 and attach K-1(s) for each partner.

Include on Line 20, Other Income, any federal/state depreciation differences.

LINE 14. If you had gains or losses from the sale of real estate, stocks or bonds, or gains or losses from capital assets from partnerships, S corporations, or fiduciaries, enter your taxable share. Adjust the amount of gain or loss for any federal/state depreciation differences.

Arkansas did not adopt the federal “bonus depreciation” provision from previous years. Therefore, there may be a difference in federal and Arkansas amounts of depreciation allowed. Adjustyourgains and losses for depreciation differences, if any, in the federal and Arkansas amounts on Lines 2, 5 and 10 of the Arkansas Form AR1000D.

If, after the netting process, you had a capital gain or loss reported on federal Schedule D or on Form 1040/1040A, use Arkansas Form AR1000D to determine the taxable amount to enter. Attach federal Schedule D and Arkansas Form AR1000D to your return.

The amount of capital loss that can be deducted after offsetting capital gains is limited to $3,000 ($1,500 per taxpayer for filing Status 4 or 5). If your capital loss was more than the yearly limit on capital loss deductions, you can carry over the unused part to later years until used up.

The gain on the sale of your personal residence is exempt up to $250,000 per taxpayer ($500,000 for married couples filing on the same return). The property must, during the 5 year period ending on the day of sale, be owned and used by the taxpayer(s) as the principal residence for periods aggregating 2 years or more.

LINE 15. Enter the ordinary gain or (loss) from Part Il of federal Form 4797. Adjust for any differences in Arkansas and federal depreciation. The capital loss limit does not apply. Attach federal Form 4797 and/or 4684 if applicable.

LINE 16. Use this line to report taxable lump- sum distributions, annuities, and traditional IRA distributions. Include early withdrawal of traditional IRA distributions on this line. List only the amount of withdrawal and attach the federal Form 5329 showing the tax on premature distribution. Also, enter ten percent (10%) of the tax from the federal Form 5329, Part | and Part Il, on Line 30. If you received a distribution which does not qualify for the Lump-Sum Distribution Averaging Schedule (AR1000TD), list the total distribution

received in 2016. (See AR1000TD to determine if you qualify to use the averaging method.) Attach 1099-R(s).

Premature distributions are amounts you withdrew from your traditional IRA, deferred compensation, or thrift savings plans before you were either age 59 % or disabled. Rollovers on distributions are tax exempt.

NOTE: /f you filed a claim under McFadden v. Weiss or Maples v. Weiss and your basis has been fully recovered, enter the amount from Box 1 of your 1099-R(s) as the “Gross” and “Taxable Amount” on

Line 17A or B.

LINE 17A. If you had income from an employment-related pension plan or a qualified traditional IRA distribution, enter the gross amount(s) from Box 1 of your 1099-R(s) in the space provided. Enter the federal taxable amount from Box 2a of your 1099-R(s) in the space provided. If Box 2a is blank, use the Simplified Method Worksheet in the federal 1040 Instruction Booklet to calculate the taxable amount of your distribution. You are entitled to a $6,000 exemption from the taxable amount; the balance is taxable to Arkansas. Enter the balance on Line 17A, Column A. Attach 1099-R(s).

FILING STATUS 2 (Married Filing Joint) ONLY: If you and your spouse both had income from a retirement plan and/or qualified traditional IRA. distribution, enter the combined gross income amount from Box 1 of your 1099-R(s). Enter the combined federal taxable amount from Box 2a of your 1099-R(s). If Box 2a is blank, use the Simplified Method Worksheet in the federal 1040 Instruction Booklet to calculate the taxable amount of your distribution. Both you and your spouse are entitled toa $6,000 exemption from your respective taxable retirement plan income; the balance is taxable to Arkansas. Enter the balance on Line 17A. Attach 1099-R(s).

LINE 17B. FILING STATUS 4 (Married Filing Separately on the Same Return) ONLY: If your spouse had income from an employment related pension plan or a qualified traditional IRA distribution, enter the gross income from Box 1 of his or her 1099-R(s). Enter the federal taxable amount from Box 2a of his or her 1099-R(s). If Box 2a is blank, use the Simplified Method Worksheet in the federal 1040 Instruction Booklet to calculate the taxable amount of his or her distribution. Your spouse is entitled to a $6,000 exemption from the taxable amount; the balance is taxable to Arkansas. Enter the balance on Line 17B. Attach 1099-R(s).

You are eligible for the $6,000 exemption for retirement or disability benefits provided the distribution was from public or private employment- related retirement systems, plans, or programs. (The recipient does not have to be retired.) The method of funding is irrelevant. The exemption may be taken from either lump-sum or installment payments. The early withdrawal penalty may be applicable even though the exemption is granted.

If you received a traditional IRA distribution after reaching the age of fifty-nine and one-half (59 1/2), the first $6,000 is exempt from tax. Premature distributions made on account of the participant's death or disability also qualify for the exemption. All other premature distributions or early withdrawals including, but not limited to, those taken for medical expenses, higher education expenses, or a first-time home purchase do not qualify for the exemption.

Note: If you made nondeductible contributions to your traditional IRA, enter taxable amount from federal Form 8606 in the space provided. Attach federal Form 8606.

LINE 18. If you had income from rents, royalties, estates or trusts, profits (whether received or not) from partnerships, fiduciaries, small business corporations, etc., enter the amounts as reported on your federal Schedule E. If you are filing a return for a taxable year that is not the same as the annual accounting period of your partnership or trust, report your distributive share(s) of net profits in the accounting period that ends in your taxable year. Attach federal Schedule E.

Nonresident beneficiaries pay tax only on Arkansas income.

LINE 19. If you had farm income, enter the amount reported on your federal Schedule F. Farm income may not be split between you and your spouse unless a partnership was legally established. Partnership income must be reported on Form AR1050, with K-1(s) for each partner. Attach federal Schedule F.

LINE 20. Enter net other income/loss and depreciation differences. Attach Form AR-OI. Some examples of what must be reported are:

Gambling winnings of any type , with the following exception: Gambling winnings from Arkansas electronic games of skill are not included as income and the 3% tax withheld is excluded from Line 37.

Reimbursement of medical expenses from a previous year: if you itemized deductions in that year and it reduced your tax.

Amounts recovered on bad debts that you deducted in an earlier year.

Net operating loss (NOL) from an earlier year to carry forward to 2016: enter as a negative amount on Form AR-OI. Attach a statement showing how you calculated the amount of loss and the year the loss occurred. A net operating loss may be carried forward for five (5) years. (NOL carrybacks not allowed.)

Scholarships, fellowships, and grants: A qualified scholarship, fellowship, or grant is exempt from tax only if:

1) You were a candidate for a degree at an educational institution, and

2) Received a qualified scholarship, fellowship, or grant.

A qualified scholarship, fellowship, or grant is any amount you received that was used under the terms of the grant for:

1) Tuition and fees required for enrollment, or

2) Fees, books, supplies and equipment required for the course(s) at the educational institution. (These items must have been required of all students in that course.)

Foreign students who are exempt from federal taxes because of a tax treaty must file and pay tax on all income including non-qualified scholarship or fellowship income.

Stipends are taxable. LINE 21. Add Lines 8 through 20 and enter total

in the appropriate columns on this line. This is your Total Income.

ADJUSTMENTS

LINE 22. If you are claiming an adjustment from the list below, use Form AR1000AD4J and include the total on this line. Attach Form AR1000ADJ.

Border city/Texarkana exemption

Arkansas Tax Deferred Tuition Savings Program Payments to IRA

Payments to MSA

Payments to HSA

Deduction for interest paid on student loans Contributions to Intergenerational Trust

Moving expenses

Self-employed health insurance deduction KEOGH, Self-employed SEP and Simple Plans Forfeited interest penalty for premature with- drawal

Alimony/Separate Maintenance Paid

Support for permanently disabled individual Organ Donor Deduction

Military Reserve Expenses

Reforestation Deduction

LINE 23. Subtract Line 22 from Line 21, Total Income. Enter amount on this line. This is your Adjusted Gross Income (AGI).

LINE 24. Enter the amount(s) from Line 23, Columns A and B.

TAX COMPUTATION

LINE 25. SELECT THE PROPER TAX TABLE and check the appropriate box. You will be in one of the following categories:

1) You qualify for the Low Income Tax Table, or 2) You must use the Regular Tax Table

See tax tables and qualifications for each table on pages 22-28.

If you use an exclusion for active duty military com- pensation, employer sponsored pension income, ora qualified traditional IRA distribution, you do not qualify for a Low Income Tax Table. You may elect NOT TO USE the exclusion(s) to which you are entitled and use a Low Income Tax Table if you fall within the income limits.

Caution: If you qualify to use a Low Income Tax Table, enter zero (0) on Line 25, Column A. (The Standard Deduction is already built into the table.)

If you use the regular tax table, enter the larger of your itemized deductions (from Form AR3) or your Standard Deduction on Line 25.

Itemized Deductions:

To compute your itemized deductions, complete Form AR3 and attach it to your return. Make sure that your total itemized deductions exceed the Standard Deduction. (For Form AR3 instructions see pages 16-17 of this booklet.)

NOTE: /f you are filing Status 4 or 5 and one spouse itemizes, then both spouses must itemize. (If you are filing status 5 and your spouse itemizes on a separate return, check the appropriate box.)

Standard Deduction:

The Standard Deduction for your filing status is the amount shown below. (If the amount on Line 24 is less than the Standard Deduction, enter the amount from Line 24 on Line 25.)

Filing Standard

Status Deduction

1-Single $2,200

2-Married Filing Joint $4,400

3—Head of Household $2,200

4-Married Filing Separately $2,200 each on Same Return

5—Married Filing Separately $2,200 on Different Returns

6—Qualifying Widow(er) $2,200

NOTE: The $2,200 Standard Deduction does

not apply to taxpayer’s dependent(s).

LINE 26. Subtract Line 25 from Line 24. This is your Net Taxable Income.

LINE 27. Using the appropriate tax table locate the tax for your income and enter here.

LINE 28. Add Lines 27(A) and 27(B) and enter the total.

LINE 29. If you received a lump-sum (total) distribution from a qualified retirement plan during 2016, you may be eligible to use the averaging method to figure some of your tax at a lower rate. Read the instructions for Form AR1000TD to determine if you are eligible to use this method. If so, complete Form AR1000TD and enter amount here. Attach Form AR1000TD.

Page 13

LINE 30. Taxpayers subject to additional tax on their federal return from a traditional IRA or employer qualified retirement plan are subject to additional tax on their state return. Enter ten percent (10%) of the federal amount from Part | of federal Form 5329. Be sure to enter total distribution(s) from Part |, Form 5329, on Line 16 or 17 of Form AR1000F/AR1000NR.

Taxpayers subject to additional tax on a distribution from a Coverdell Education Savings Account, include ten percent (10%) of the federal amount from Part II of federal Form 5329 on this line. Be sure to include the taxable amount of the Coverdell Education Savings Account distribution on Line 20 of Form AR1000F/AR1000NR (Other Income).

LINE 31. Add Lines 28 through 30 and enter the total.

TAX CREDITS

LINE 32. Enter the total personal tax credits from Line 7D.

LINE 33. The Child Care Credit allowed is twenty percent (20%) of the amount allowed on your federal return. A copy of federal Form 2441, “Credit for Child and Dependent Care Expenses” must be attached to your Arkansas return.

If you are claiming the Early Childhood Program Credit on Line 41, the total amounts from Line 33 and Line 41 can not exceed (20%) of the amount allowed on federal Form 2441,

LINE 34. Complete Form AR1000TC if you are eligible for any credit(s) listed below and include the total on this line. Attach Form AR1000TC.

State Political Contribution Credit Other State Tax Credit

Credit for Adoption Expenses Phenylketonuria Disorder Credit Business Incentive Tax Credit(s)

LINE 35. Add Lines 32 through 34 and enter the total.

LINE 36. Subtract Line 35 from Line 31. This is your Net Tax. If Line 35 is greater than Line 31, enter zero (0).

If Total Credits on Line 35 is more than Total Tax on Line 31, the difference is not refundable.

NOTE: If your net tax is $1,000 or more, and you failed to make a declaration of Estimated Tax (Form AR1000ES, Voucher 1), or pay withholding equal to 90% of your net tax, a penalty of ten percent (10%) will be assessed. See instructions for Lines 50A and 50B for more information.

Page 14

PRORATION

IF FILING A FULL YEAR RESIDENT RETURN, go to instructions for Line 37. The instructions for Line 36A through Line 36D apply only to nonresidents and part year residents.

NONRESIDENTS AND PART YEAR RESIDENTS ONLY, read the following instructions to determine your correct Arkansas tax liability. Attach a complete copy of your federal return.

LINE 36A. Enter adjusted gross income from Line 23, Column C.

LINE 36B. Enter total of Columns A and B from Line 23.

LINE 36C. Divide amount on Line 36Aby amount on Line 36B to arrive at your Arkansas percentage of income. Enter percentage as a decimal rounded to six places. Do not exceed 100%.

Example: $2,500/$525,000 = 0.004762 or $10,000/$60,000 = 0.166667

LINE 36D. Multiply amount on Line 36 by decimal on Line 36C for Arkansas apportioned tax liability.

PAYMENTS

LINE 37. Enter Arkansas tax withheld from your W-2(s)/1099(s). You have already paid this amount of tax during the year. If you have MORE THAN ONE W-2/1099, be sure to add the Arkansas income tax withheld from all W-2(s)/1099(s). Enter the total withheld.

IF YOUAND YOUR SPOUSE ARE FILING ON THE SAME RETURN, add the Arkansas state income tax withheld from all your W-2(s)/1099(s). Enter the combined total withheld.

If you did not receive (or lost) your W-2(s) and Arkansas tax was withheld from your income, you should take the following steps IN THE ORDER LISTED BELOW:

1) Ask your employer for copies of your W-2(s). If you cannot obtain them from your employer you should

2) Contact the Social Security Administration at (800) 772-1213. Only if you cannot obtain your W-2(s) from your employer or SSA you may

3) Complete federal Form 4852 and attach a copy of your final pay stub to

support your amounts.

CAUTION: You WILL NOT receive credit for tax withheld or receive a tax refund, unless you attach CORRECT AND LEGIBLE W-2(s) or other approved documentation to your tax return.

DO NOT include FICA, federal income tax, tax paid to another state or 3% tax withheld from winnings on electronic games of skill. Gambling winnings from Arkansas electronic games of skill are not included as income and the 3% tax withheld is excluded from Line 37.

DO NOT correct a W-2 yourself. Your employer must issue you a corrected W-2.

LINE 38. If you made an estimated declaration and paid estimated tax payments on 2016 income OTHER THAN wages, salaries, tips, etc., write the total paid in this space. The only amount to enter here is total payments you made on a 2016 Declaration of Estimated Income Tax (includes January 15, 2017 installment and/or credit brought forward from 2015 tax return).

DO NOT include PENALTIES OR INTEREST as part of the amount paid.

If you and your spouse filed a JOINT declaration and you and your spouse choose to file your tax returns on separate forms this year, payments made under the joint declaration of estimate will be credited to the primary filer.

If you are filing prior year tax returns past the due date of the tax return, the refund/ overpayment from those tax returns can- not be carried forward as estimated tax.

LINE 39. If you filed an Arkansas extension request and paid tax with your request, enter the amount paid.

LINE 40. PREVIOUS PAYMENTS: This line is for amended returns only. Enter the total of any previous payment(s) made with your original return and/or billing notices and amended return(s).

LINE 41. Enter the APPROVED Early Childhood Program Credit (20% of the federal child care credit). This is for individuals with a dependent child placed in an APPROVED child care facility while the parent or guardian worked or pursued employment. (Facility must be approved by the Arkansas Department of Education as having an appropriate early childhood program as defined by Arkansas law.) Enter the certification number and attach federal Form 2441 and Certification Form AR1000EC. Contact your child care facility for Form AR1000EC.

If you are claiming the Early Childhood Program Credit on Line 41, the total amounts from Line 33 and Line 41 can not exceed (20%) of the amount allowed on federal Form 2441.

LINE 42. Add the amounts on Lines 37,38,39,40 and 41. This is your TOTAL PAYMENTS.

LINE 43. PREVIOUS REFUND: This line is for amended returns only. Enter the total of any previous refund(s) from your original return and amended return(s).

LINE 44. Subtract Line 43 from Line 42. This is your ADJUSTED TOTAL PAYMENTS.

ITAR161

2016 AR1000F | |i

ARKANSAS INDIVIDUAL INCOME TAX RETURN

ll AR1

CHECK BOX IF

Full Year Resident vept.useony - AMENDED RETURN Software ID Jan. 1 - Dec. 31, 2016 or fiscal year ending , 20 e e e e| DFAWEB PRIMARY FIRST NAME MI LAST NAME PRIMARY SOCIAL SECURITY NUMBER e e e e ae SPOUSE FIRST NAME MI LAST NAME SPOUSE’S SOCIAL SECURITY NUMBER we e e e e ot go ue MAILING ADDRESS (number and Street, P.O. Box or Rural Route) Check here if you do NOT want a Bele O tax booklet mailed to you next year.| CITY STATE or PROVINCE ZIP COUNTRY (if not U.S.) e e e x] 12 | SINGLE (Or widowed before 2016 or divorced at end of 2016) 4.0 | MARRIED FILING SEPARATELY ON THE SAME RETURN oa es 2.e@ | MARRIED FILING JOINT (Even if only one had income) 5.@ | MARRIED FILING SEPARATELY ON DIFFERENT RETURNS 5 n> 96 3.0 | HEAD OF HOUSEHOLD (See Instructions) Enter spouse’s name here and SSN above Sx zs If the qualifying person was your child, but not your dependent, 6.0 | QUALIFYING WIDOW(ER) with dependent child ° enter child's name here: Year spouse died: (See /nstructions) > Check this box if you have filed a state extension or an automatic federal extension HEAD OF HOUSEHOLD/QUALIFYING WIDOW(ER) 7A[_]vourseLr e[_]65oroveR e[_]e6ssPeciaL e[_]| BLIND e[ |dear [| AD OF HOUSEHOLDIQUALIFVING WIDOWER) [_]spouse e[ ]e5orover e[ ]6ssPeciAL e[_] BLIND e[_| DEAF Multiply number of boxes checked = 00 £ | Dependents (Do not list yourself or spouse) 8 First Name Last Name Dependent’s Social Security Number Dependent's relationship to you 4 o x = a z 2 i) g . FA 7B. Multiply number of dependents from ADOVE ............essesessesessesesesesesscsessessesesueseeneeeeeesesecseseteusenenceneneeneeeeees 7B @ | X $26 = 00 7C. First name of individual(s) with developmental disability: (See Instructions) Multiply number of individuals with developmental disabilities from 7C 00 7D. TOTAL PERSONAL TAX CREDITS: (Add Lines 7A, 7B, and 7C. Enter total here and on Line 32) 00 (A) Your/Joint (B) Spouse’s Income ROUND ALL AMOUNTS TO WHOLE DOLLARS Income Status 4 Only 8. Wages, salaries, tips, etc: (Attach W-2s) e loo e [oo 9A. U.S. Military compensation: (Yourjoint gross amount) |e oo] 9A 9B. U.S. Military compensation: (Spouse’s gross amount) |e oo} 9B 10. Interest income: (If over $1,500, attach AR4) e OOje 00) 11. Dividend income: (If over $1,500, attach AR4) e OO} e 00 12. Alimony and separate maintenance received:. oe OO|e 00 13. Business or professional income: (Attach federal Schedule C or C-EZ) .....c.ccccececceteeeeeeeeeeees e@ OO|e 00 14. Capital gains/(losses) from stocks, bonds, etc: (See Instr. Attach Schedule D, e OO|e 00 15. Other gains or (losses): (Attach federal Form 4797 and/or 4684 if applicable) o oe OO|e 00 16. Non-Qualified IRA distributions and taxable annuities: (Attach All 1099RS)..........ccescecesseseeseees e@ Oo|e 00 17AYour/Joint Employer pension plan(s)/Qualified IRA(s): (See Instructions - Attach All 1099Rs) Gross Distribution [> ~—_ foo Taxable Amount | CR (0) Ax 7A\2 00 17B.Spouse’s Employer pension plan(s)/Qualified IRA(s): (Filing Status 4 Onl, Gross Distribution [> ———_ Joo Taxable Amount |¢ 00 seco! 7B e 00 18. Rents, royalties, partnerships, estates, trusts, etc: (Attach federal Schedule E)...........:c:0c00 18 |@ OOle 00 19. Farm income: (Attach federal SCh@UI@ F)).......c.cececeesseeeeeeeeseeeeeeeeeeeeeeeseeeeeeeeeseeeeseeeseeeseeieeeee e OO|e 00 20. Other income/depreciation differences: (Attach Form AR-Ol) oe OO|e 00 21, TOTAL INCOME: (Add Lines 8 through 20) e OO} e 00} 22. TOTAL ADJUSTMENTS: (Attach Form AR1000ADJ) ° Oo}e 00} 23. ADJUSTED GROSS INCOME: (Subtract Line 22 from Lin€ 21)..........1cc0csssseeeseteee tees 23 |@ Oo}e 00

Page AR1 (R 8/31/2016)

IN AR2

ITAR162 Primary SSN - - (A) Your/Joint (B) Spouse’s Income Income Status 4 Only 24. ADJUSTED GROSS INCOME: (From Line 23, Columns A and B) .....sccsssssssseeessseees 24 00 00 25. Select tax table: (See Instructions, Line 25) eC] Low INCOME Table (J REGULAR Table Fs If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then: & Enter e oO Itemized Deductions (See /nstructions, Line 25 and attach AR3) 2 the larger OR _ If your spouse itemizes on a separate return, check here @ oO 5 of your: CO standard Deduction (See Instructions, Line 25) 00} e@ 00 x 26. NET TAXABLE INCOME: (Subtract Line 25 from Line 24) 00 F | 27. TAX: (Enter tax from tax table)... 00 28. Combined tax: (Add amounts from Line 27, Columns A and B) 00 29. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) .........:ccccccsseseseeteteeseeeeeeeeeeteeeeeteeaes 29 @ 00 30. Additional tax on IRA and qualified plan withdrawal and overpayment: (Attach federal Form 5329, if required) . 30 @| 00 31. TOTAL TAX: (Add Lines 28 through 30) . 31 @| 00 @ | 32. Personal Tax Credit(s): (Enter total from Lin@ 7D)... eeectecceeeeeeeecenenesnneeennes 00 E 33. Child Care Credit: (20% of federal credit allowed; Attach federal Form 2441) 00 & 34. Other Credits: (Attach AR1000TC) 00 % | 35. TOTAL CREDITS: (Add Lines 32 through 34)... 35 @ 00 | 36. NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter 0) 36 @ 00 . Arkansas income tax withheld: [Attach state copies of W-2 and/or 1099R Form(s)]. E . AMENDED RETURNS ONLY - Previous payments: (See instructions) ...........0:c:c1ceee u 41. Early childhood program: Certification Number: & (20% of federal credit; Attach federal Form 2441 and Form AR1000EC) .........s00ccseeeeee 41 @| (ele) 42. TOTAL PAYMENTS: (Add Lines 37 through 41)......c.cccccccescscsseseeeseseeeeeeeeseeeeseeeeeeeeeseseeeessseseeeeeaseseeseensneesseeeeeeeeee 42 @ 00 43. AMENDED RETURNS ONLY - Previous refund: (See iNStructiONS) ...........cccccccccccse eee eceeee ee ceeseeeceeeeseseeeesesenecenesaeeeeeeee 43 @ 00 44. Adjusted Total Payments: (Subtract Line 43 from Line 42).... . 44 @ 00 45. AMOUNT OF OVERPAYMENT/REFUND: (/f Line 44 is greater than Line 36, enter difference) . 45 @ 00 46. Amount to be applied to 2017 estimated tax! ........0.cccccecceeee 00 47. Amount of Check-off Contributions: (Attach Schedule AR1000-CO). 47 @ 00 - 48. AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 46 and 47 from Line 45). REFUND 48 e|© 00 a DIRECT DEPOSIT? If your deposit will be ultimately placed in a foreign account check the box. @ CL] g Routing Number Account Number e CL] Checking or o| @ e . 2 e CL] Savings 49. AMOUNT DUE: (If Line 44 is less than Line 36, enter difference; If over $1,000, continue to 50A).......... TAX DUE 49 &—_—_—*0| 50A.UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 50A @ CL] Penalty 50B@ 00 50C.Add Lines 49 and 50B. Attach Form AR1000V with check or money order payable in U.S. Dollars to “Dept. of Finance and Administration”. Include your SSN on payment. To pay by credit card, see instructions... TOTAL DUE 50Ce 00 51. Amount of income not subject to Arkansas tax from AR4, Part Ill: (Memorandum only) May the Arkansas Revenue Agency discuss this return with the preparer of the return? ] C Yes Oo No PLEASE SIGN HERE: Under penalties of perjury, | declare that | have examined this return and npanying scl and ents, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your Signature Date E-mail: Telephone: le Spouse’s Signature Date E-mail: Telephone: le FA Paid Preparer’s Signature iD Number/Social Security Number ae . A e ag Preparer’s Name: City/State/Zip: Telephone: &/ E-mail:

Page AR2 (R 10/5/2016)

ITAR161

2016 AR1000F | |i

ARKANSAS INDIVIDUAL INCOME TAX RETURN

ll AR1

CHECK BOX IF

Full Year Resident vept.useony - AMENDED RETURN Software ID Jan. 1 - Dec. 31, 2016 or fiscal year ending , 20 e e e e| DFAWEB PRIMARY FIRST NAME MI LAST NAME PRIMARY SOCIAL SECURITY NUMBER e e e e ae SPOUSE FIRST NAME MI LAST NAME SPOUSE’S SOCIAL SECURITY NUMBER we e e e e ot go ue MAILING ADDRESS (number and Street, P.O. Box or Rural Route) Check here if you do NOT want a Bele O tax booklet mailed to you next year.| CITY STATE or PROVINCE ZIP COUNTRY (if not U.S.) e e e x] 12 | SINGLE (Or widowed before 2016 or divorced at end of 2016) 4.0 | MARRIED FILING SEPARATELY ON THE SAME RETURN oa es 2.e@ | MARRIED FILING JOINT (Even if only one had income) 5.@ | MARRIED FILING SEPARATELY ON DIFFERENT RETURNS 5 n> 96 3.0 | HEAD OF HOUSEHOLD (See Instructions) Enter spouse’s name here and SSN above Sx zs If the qualifying person was your child, but not your dependent, 6.0 | QUALIFYING WIDOW(ER) with dependent child ° enter child's name here: Year spouse died: (See /nstructions) > Check this box if you have filed a state extension or an automatic federal extension HEAD OF HOUSEHOLD/QUALIFYING WIDOW(ER) 7A[_]vourseLr e[_]65oroveR e[_]e6ssPeciaL e[_]| BLIND e[ |dear [| AD OF HOUSEHOLDIQUALIFVING WIDOWER) [_]spouse e[ ]e5orover e[ ]6ssPeciAL e[_] BLIND e[_| DEAF Multiply number of boxes checked = 00 £ | Dependents (Do not list yourself or spouse) 8 First Name Last Name Dependent’s Social Security Number Dependent's relationship to you 4 o x = a z 2 i) g . FA 7B. Multiply number of dependents from ADOVE ............essesessesessesesesesesscsessessesesueseeneeeeeesesecseseteusenenceneneeneeeeees 7B @ | X $26 = 00 7C. First name of individual(s) with developmental disability: (See Instructions) Multiply number of individuals with developmental disabilities from 7C 00 7D. TOTAL PERSONAL TAX CREDITS: (Add Lines 7A, 7B, and 7C. Enter total here and on Line 32) 00 (A) Your/Joint (B) Spouse’s Income ROUND ALL AMOUNTS TO WHOLE DOLLARS Income Status 4 Only 8. Wages, salaries, tips, etc: (Attach W-2s) e loo e [oo 9A. U.S. Military compensation: (Yourjoint gross amount) |e oo] 9A 9B. U.S. Military compensation: (Spouse’s gross amount) |e oo} 9B 10. Interest income: (If over $1,500, attach AR4) e OOje 00) 11. Dividend income: (If over $1,500, attach AR4) e OO} e 00 12. Alimony and separate maintenance received:. oe OO|e 00 13. Business or professional income: (Attach federal Schedule C or C-EZ) .....c.ccccececceteeeeeeeeeeees e@ OO|e 00 14. Capital gains/(losses) from stocks, bonds, etc: (See Instr. Attach Schedule D, e OO|e 00 15. Other gains or (losses): (Attach federal Form 4797 and/or 4684 if applicable) o oe OO|e 00 16. Non-Qualified IRA distributions and taxable annuities: (Attach All 1099RS)..........ccescecesseseeseees e@ Oo|e 00 17AYour/Joint Employer pension plan(s)/Qualified IRA(s): (See Instructions - Attach All 1099Rs) Gross Distribution [> ~—_ foo Taxable Amount | CR (0) Ax 7A\2 00 17B.Spouse’s Employer pension plan(s)/Qualified IRA(s): (Filing Status 4 Onl, Gross Distribution [> ———_ Joo Taxable Amount |¢ 00 seco! 7B e 00 18. Rents, royalties, partnerships, estates, trusts, etc: (Attach federal Schedule E)...........:c:0c00 18 |@ OOle 00 19. Farm income: (Attach federal SCh@UI@ F)).......c.cececeesseeeeeeeeseeeeeeeeeeeeeeeseeeeeeeeeseeeeseeeseeeseeieeeee e OO|e 00 20. Other income/depreciation differences: (Attach Form AR-Ol) oe OO|e 00 21, TOTAL INCOME: (Add Lines 8 through 20) e OO} e 00} 22. TOTAL ADJUSTMENTS: (Attach Form AR1000ADJ) ° Oo}e 00} 23. ADJUSTED GROSS INCOME: (Subtract Line 22 from Lin€ 21)..........1cc0csssseeeseteee tees 23 |@ Oo}e 00

Page AR1 (R 8/31/2016)

IN AR2

ITAR162 Primary SSN - - (A) Your/Joint (B) Spouse’s Income Income Status 4 Only 24. ADJUSTED GROSS INCOME: (From Line 23, Columns A and B) .....sccsssssssseeessseees 24 00 00 25. Select tax table: (See Instructions, Line 25) eC] Low INCOME Table (J REGULAR Table Fs If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then: & Enter e oO Itemized Deductions (See /nstructions, Line 25 and attach AR3) 2 the larger OR _ If your spouse itemizes on a separate return, check here @ oO 5 of your: CO standard Deduction (See Instructions, Line 25) 00} e@ 00 x 26. NET TAXABLE INCOME: (Subtract Line 25 from Line 24) 00 F | 27. TAX: (Enter tax from tax table)... 00 28. Combined tax: (Add amounts from Line 27, Columns A and B) 00 29. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) .........:ccccccsseseseeteteeseeeeeeeeeeteeeeeteeaes 29 @ 00 30. Additional tax on IRA and qualified plan withdrawal and overpayment: (Attach federal Form 5329, if required) . 30 @| 00 31. TOTAL TAX: (Add Lines 28 through 30) . 31 @| 00 @ | 32. Personal Tax Credit(s): (Enter total from Lin@ 7D)... eeectecceeeeeeeecenenesnneeennes 00 E 33. Child Care Credit: (20% of federal credit allowed; Attach federal Form 2441) 00 & 34. Other Credits: (Attach AR1000TC) 00 % | 35. TOTAL CREDITS: (Add Lines 32 through 34)... 35 @ 00 | 36. NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter 0) 36 @ 00 . Arkansas income tax withheld: [Attach state copies of W-2 and/or 1099R Form(s)]. E . AMENDED RETURNS ONLY - Previous payments: (See instructions) ...........0:c:c1ceee u 41. Early childhood program: Certification Number: & (20% of federal credit; Attach federal Form 2441 and Form AR1000EC) .........s00ccseeeeee 41 @| (ele) 42. TOTAL PAYMENTS: (Add Lines 37 through 41)......c.cccccccescscsseseeeseseeeeeeeeseeeeseeeeeeeeeseseeeessseseeeeeaseseeseensneesseeeeeeeeee 42 @ 00 43. AMENDED RETURNS ONLY - Previous refund: (See iNStructiONS) ...........cccccccccccse eee eceeee ee ceeseeeceeeeseseeeesesenecenesaeeeeeeee 43 @ 00 44. Adjusted Total Payments: (Subtract Line 43 from Line 42).... . 44 @ 00 45. AMOUNT OF OVERPAYMENT/REFUND: (/f Line 44 is greater than Line 36, enter difference) . 45 @ 00 46. Amount to be applied to 2017 estimated tax! ........0.cccccecceeee 00 47. Amount of Check-off Contributions: (Attach Schedule AR1000-CO). 47 @ 00 - 48. AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 46 and 47 from Line 45). REFUND 48 e|© 00 a DIRECT DEPOSIT? If your deposit will be ultimately placed in a foreign account check the box. @ CL] g Routing Number Account Number e CL] Checking or o| @ e . 2 e CL] Savings 49. AMOUNT DUE: (If Line 44 is less than Line 36, enter difference; If over $1,000, continue to 50A).......... TAX DUE 49 &—_—_—*0| 50A.UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 50A @ CL] Penalty 50B@ 00 50C.Add Lines 49 and 50B. Attach Form AR1000V with check or money order payable in U.S. Dollars to “Dept. of Finance and Administration”. Include your SSN on payment. To pay by credit card, see instructions... TOTAL DUE 50Ce 00 51. Amount of income not subject to Arkansas tax from AR4, Part Ill: (Memorandum only) May the Arkansas Revenue Agency discuss this return with the preparer of the return? ] C Yes Oo No PLEASE SIGN HERE: Under penalties of perjury, | declare that | have examined this return and npanying scl and ents, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your Signature Date E-mail: Telephone: le Spouse’s Signature Date E-mail: Telephone: le FA Paid Preparer’s Signature iD Number/Social Security Number ae . A e ag Preparer’s Name: City/State/Zip: Telephone: &/ E-mail:

Page AR2 (R 10/5/2016)

2016 AR1000NR ill

ITNR1

ARKANSAS INDIVIDUAL INCOME TAX RETURN

Nonresident and Part Year Resident

61

Dept. Use Only

CHECK BOX IF AMENDED RETURN

NR1

Software ID

Jan. 1 - Dec. 31, 2016 or fiscal year ending , 20 e e e e| DEAWEB IPRIMARY FIRST NAME MI LAST NAME PRIMARY SOCIAL SECURITY NUMBER e e e e ISPOUSE FIRST NAME MI LAST NAME SPOUSE’S SOCIAL SECURITY NUMBER e e e e

USE LABEL OR PRINT OR TYPE

IMAILING ADDRESS (Number and Street, P.O. Box or Rural Route)

COUNTRY (if not U.S.)

e CITY STATE OR PROVINCE zip e oO Check here if you do NOT want a tax e e e booklet mailed to you next year. NONRESIDENT: e PART YEAR RESIDENT: eL] (List State of residence) (Dates Lived in AR)

FILING STATUS (Check Only One Box

1.0 LC] SINGLE (Or widowed before 2016 or divorced at end of 2016) 2.@ L] MARRIED FILING JOINT (Even if only one had income)

3.e[_] HEAD OF HOUSEHOLD (See Instructions) If the qualifying person was your child but not your dependent, enter child’s name here:

4.e@ | MARRIED FILING SEPARATELY ON THE SAME RETURN

5.e

6.e CL QUALIFYING WIDOW(ER) with dependent child

Enter spouse’s name here and SSN above

Year spouse died: (See /nstructions)

LJ MARRIED FILING SEPARATELY ON DIFFERENT RETURNS

>

*O

Check this box if you have filed a state extension or an automatic federal extension

7A[_]Yoursetr e[_]65orover e[_]esspeciaL e[_] BLIND e[ | DEAF [_] HEAD OF HOUSEHOLD/QUALIFYING WIDOWER)

| SPOUSE el] 65 or OVER eL] 65 SPECIAL eC] BLIND @ C] DEAF

(Filing Status 3 Only)

(Filing Status 6 Only)

Multiply number of boxes checked = 00 Dependents (Do not list yourself or spouse) 4 First Name Last Name Dependent’s Social Security Number Dependent’s relationship to you o Z z 5 @ 4 7B. Multiply number of dependents from above.. = 00 7C. First name of individual(s) with developmental disability: (See Instructions) Multiply number of individuals with developmental disabilities from 7C = 00 7D. TOTAL PERSONAL TAX CREDITS: (Add Lines 7A, 7B, and 7C. Enter total here and on Line 32)...........:.:.0000 7D 00 (A) Your/Joint | (B) Spouse’s Income| (C) Arkansas ROUND ALL AMOUNTS TO WHOLE DOLLARS Income ‘Status 4 Only Income Only 8. Wages, salaries, tips, etc: (Attach W-2s) 8 |e [00]e 00|e [oo 9A. U.S. Military compensation: (Yourjoint gross amt.) 9B. U.S. Military compensation: (Spouse’s gross amt.) 10. Interest income: (If over $1,500, attach AR4).... le O0}e O0}e 00 41. Dividend income: (If over $1,500, attach AR4) le O0}e 00|e 00 12. Alimony and separate maintenance received: je 00}e 00}e 00 13. Business or professional income: (Attach federal Schedule C or C-EZ)......-::0:0++ le 00Je 00}e 00 14. Capital gains/(losses) from stocks, bonds, etc: (See Instr. Attach Schedule D).. le O0}e O0le 00 15. Other gains or (losses): (Attach federal Form 4797 and/or 4684 if applicable, je 00} 00le 00 16. Non-Qualified IRA distributions and taxable annuities: (Attach All 1099Rs) hd 00} 00|e 00 17A. Your/Joint Employer pension plan(s)/Qualified IRA(s):(See Instructions, Attach All 1099Rs) Gross Distribution fe ————* 00] Taxable Amountle [00] sk $01 7A\@ 00 le 00 17B. Spouse Employer pension plan(s)/Qualified IRA(s): (Filing Status 4 only) Gross Distribution fe =~ | Taxable Amountfe [00] gS! 7B le 00}e 00 18. Rents, royalties, partnerships, estates, trusts, etc.: (Attach federal Schedule E)......18 |® 00\e 00|e 00 19. Farm income: (Attach federal Schedule F) le 00}e 00}e 00 20. Other income/depreciation differences: (Attach Form AR-Ol) je 00\e 00|e 00 21. TOTAL INCOME: (Add Lines 8 through 20) . le O0}e 00}e 00 22. TOTAL ADJUSTMENTS: (Attach Form AR1000ADU) ........ccccceseseeete tees 22 |e 00le 00|e 00 23. ADJUSTED GROSS INCOME: (Subtract Line 22 from Line 21) 2.1... 23 |e 00}e 00}e 00

Page NR1 (R 9/12/16)

ITNR162 Primary SSN - - N R2 (A) Your/Joint (B) Spouse’s Income Income Status 4 Only 24. ADJUSTED GROSS INCOME: (From Line 23, Columns A and B)... 00 00 25. Select tax table: (Check the appropriate box) e(] Low INCOME Table —[[] REGULAR Table 3 If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then: E Enter el] Itemized Deductions (See /nstructions, Line 25 and attach AR3) a the larger OR If your spouse itemizes on a separate return, check here @ oO 8 of your: C1 standard Deduction (See Instructions, Line 25). 00] 25¢) 00 %|26. NET TAXABLE INCOME: (Subtract Line 25 from Line 24) 00 © 27. ‘TAX: (Enter tax from tax table) 00 28. Combined tax: (Add amounts from Line 27, Columns A and B). 00 29. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) 00 30. Additional tax on IRA and qualified plan withdrawal and overpayment: (Attach federal Form 5329, if required, 00 31. TOTAL TAX: (Add Lines 28 through 30) . 00 w# | 32. Personal Tax Credit(s): (Enter total from Line 7D, 5 33. Child Care Credit: (20% of federal credit allowed; Attach federal Form 2441, & 134. Other Credits: (Attach AR1000TC)... 2 35. TOTAL CREDITS: (Add Lines 32 through 34). 00 36. NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter O) .........csssscessevseeeeeeeeteeeeees 00 3 36A. Enter the amount from Line 23, Column C: & | 36B. Enter the total amount from Line 23, Columns A and H 36C. Divide Line 36A by 36B: (See /nstructions) ® | 36D. APPORTIONED TAX LIABILITY: (Multiply Line 36 by Line 36C)... 00 37. Arkansas income tax withheld: [Attach state copies of W-2 and/or 1099R Form(s)] . 38. Estimated tax paid or credit brought forward from 2015: 39. Payment made with extension: (See Instructions) E 40. AMENDED RETURNS ONLY - Previous payments: (See instructions, = 141. Early childhood program: Certification Number: 00 z (20% of federal credit; Attach federal Form 2441 and Form AR1000EC). 42. TOTAL PAYMENTS: (Add Lines 37 through 41) 00 43. AMENDED RETURNS ONLY - Previous refund: (See instructions) 00 44. Adjusted Total Payments: (Subtract Line 43 from Line 42 00 45. AMOUNT OF OVERPAYMENT/REFUND: (/f Line 44 is greater than Line 36D, enter difference, 00 46. 00 47. 00 , |48. AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 46 and 47 from Line 45) REFUND 42 —_—(00 > x DIRECT DEPOSIT? [f your deposit will be ultimately placed in a foreign account check the box. @ CL] t Routing Number Account Number e CL] Checking or 3 ° ° e LC] Savings 5 Z 49. AMOUNT DUE: (/f Line 44 is less than Line 36D, enter difference; If over $1,000, continue to 50A)....... TAX DUE 49 e/@) 00 50A. UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 50Ae[_ | Penalty 50B e 00 50C. Add Lines 49 and 50B. Attach Form AR1000V with check or money order payable in U.S. Dollars to “Dept. of Finance and Administration”. Include your SSN on payment. To pay by credit card, see instructions.............. TOTAL DUE 50Ce| 00 51. Amount of income not subject to Arkansas tax from AR4, Part Ill: (Memorandum only) May the Arkansas Revenue Agency discuss this return with the preparer of the return? ] O Yes oO No PLEASE SIGN HERE: Under penalties of perjury, | declare that | have examined this return and npanying sc! and ents, and to the best of my| knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your Signature Date E-mail: Telephone: le Spouse’s Signature Date E-mail: Telephone: le & Paid Preparer’s Signature WD Number/Social Security Number a _ A ° ag Preparer’s Name: City/State/Zip: Telephone: ® E-mail:

Page NR2 (R 10/5/2016)

2016 AR1000NR ill

ITNR1

ARKANSAS INDIVIDUAL INCOME TAX RETURN

Nonresident and Part Year Resident

61

Dept. Use Only

CHECK BOX IF AMENDED RETURN

NR1

Software ID

Jan. 1 - Dec. 31, 2016 or fiscal year ending , 20 e e e e| DEAWEB IPRIMARY FIRST NAME MI LAST NAME PRIMARY SOCIAL SECURITY NUMBER e e e e ISPOUSE FIRST NAME MI LAST NAME SPOUSE’S SOCIAL SECURITY NUMBER e e e e

USE LABEL OR PRINT OR TYPE

IMAILING ADDRESS (Number and Street, P.O. Box or Rural Route)

COUNTRY (if not U.S.)

e CITY STATE OR PROVINCE zip e oO Check here if you do NOT want a tax e e e booklet mailed to you next year. NONRESIDENT: e PART YEAR RESIDENT: eL] (List State of residence) (Dates Lived in AR)

FILING STATUS (Check Only One Box

1.0 LC] SINGLE (Or widowed before 2016 or divorced at end of 2016) 2.@ L] MARRIED FILING JOINT (Even if only one had income)

3.e[_] HEAD OF HOUSEHOLD (See Instructions) If the qualifying person was your child but not your dependent, enter child’s name here:

4.e@ | MARRIED FILING SEPARATELY ON THE SAME RETURN

5.e

6.e CL QUALIFYING WIDOW(ER) with dependent child

Enter spouse’s name here and SSN above

Year spouse died: (See /nstructions)

LJ MARRIED FILING SEPARATELY ON DIFFERENT RETURNS

>

*O

Check this box if you have filed a state extension or an automatic federal extension

7A[_]Yoursetr e[_]65orover e[_]esspeciaL e[_] BLIND e[ | DEAF [_] HEAD OF HOUSEHOLD/QUALIFYING WIDOWER)

| SPOUSE el] 65 or OVER eL] 65 SPECIAL eC] BLIND @ C] DEAF

(Filing Status 3 Only)

(Filing Status 6 Only)

Multiply number of boxes checked = 00 Dependents (Do not list yourself or spouse) 4 First Name Last Name Dependent’s Social Security Number Dependent’s relationship to you o Z z 5 @ 4 7B. Multiply number of dependents from above.. = 00 7C. First name of individual(s) with developmental disability: (See Instructions) Multiply number of individuals with developmental disabilities from 7C = 00 7D. TOTAL PERSONAL TAX CREDITS: (Add Lines 7A, 7B, and 7C. Enter total here and on Line 32)...........:.:.0000 7D 00 (A) Your/Joint | (B) Spouse’s Income| (C) Arkansas ROUND ALL AMOUNTS TO WHOLE DOLLARS Income ‘Status 4 Only Income Only 8. Wages, salaries, tips, etc: (Attach W-2s) 8 |e [00]e 00|e [oo 9A. U.S. Military compensation: (Yourjoint gross amt.) 9B. U.S. Military compensation: (Spouse’s gross amt.) 10. Interest income: (If over $1,500, attach AR4).... le O0}e O0}e 00 41. Dividend income: (If over $1,500, attach AR4) le O0}e 00|e 00 12. Alimony and separate maintenance received: je 00}e 00}e 00 13. Business or professional income: (Attach federal Schedule C or C-EZ)......-::0:0++ le 00Je 00}e 00 14. Capital gains/(losses) from stocks, bonds, etc: (See Instr. Attach Schedule D).. le O0}e O0le 00 15. Other gains or (losses): (Attach federal Form 4797 and/or 4684 if applicable, je 00} 00le 00 16. Non-Qualified IRA distributions and taxable annuities: (Attach All 1099Rs) hd 00} 00|e 00 17A. Your/Joint Employer pension plan(s)/Qualified IRA(s):(See Instructions, Attach All 1099Rs) Gross Distribution fe ————* 00] Taxable Amountle [00] sk $01 7A\@ 00 le 00 17B. Spouse Employer pension plan(s)/Qualified IRA(s): (Filing Status 4 only) Gross Distribution fe =~ | Taxable Amountfe [00] gS! 7B le 00}e 00 18. Rents, royalties, partnerships, estates, trusts, etc.: (Attach federal Schedule E)......18 |® 00\e 00|e 00 19. Farm income: (Attach federal Schedule F) le 00}e 00}e 00 20. Other income/depreciation differences: (Attach Form AR-Ol) je 00\e 00|e 00 21. TOTAL INCOME: (Add Lines 8 through 20) . le O0}e 00}e 00 22. TOTAL ADJUSTMENTS: (Attach Form AR1000ADU) ........ccccceseseeete tees 22 |e 00le 00|e 00 23. ADJUSTED GROSS INCOME: (Subtract Line 22 from Line 21) 2.1... 23 |e 00}e 00}e 00

Page NR1 (R 9/12/16)

ITNR162 Primary SSN - - N R2 (A) Your/Joint (B) Spouse’s Income Income Status 4 Only 24. ADJUSTED GROSS INCOME: (From Line 23, Columns A and B)... 00 00 25. Select tax table: (Check the appropriate box) e(] Low INCOME Table —[[] REGULAR Table 3 If you qualify for the Low Income Tax Table, enter zero (0) on Line 25A. If not, then: E Enter el] Itemized Deductions (See /nstructions, Line 25 and attach AR3) a the larger OR If your spouse itemizes on a separate return, check here @ oO 8 of your: C1 standard Deduction (See Instructions, Line 25). 00] 25¢) 00 %|26. NET TAXABLE INCOME: (Subtract Line 25 from Line 24) 00 © 27. ‘TAX: (Enter tax from tax table) 00 28. Combined tax: (Add amounts from Line 27, Columns A and B). 00 29. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) 00 30. Additional tax on IRA and qualified plan withdrawal and overpayment: (Attach federal Form 5329, if required, 00 31. TOTAL TAX: (Add Lines 28 through 30) . 00 w# | 32. Personal Tax Credit(s): (Enter total from Line 7D, 5 33. Child Care Credit: (20% of federal credit allowed; Attach federal Form 2441, & 134. Other Credits: (Attach AR1000TC)... 2 35. TOTAL CREDITS: (Add Lines 32 through 34). 00 36. NET TAX: (Subtract Line 35 from Line 31. If Line 35 is greater than Line 31, enter O) .........csssscessevseeeeeeeeteeeeees 00 3 36A. Enter the amount from Line 23, Column C: & | 36B. Enter the total amount from Line 23, Columns A and H 36C. Divide Line 36A by 36B: (See /nstructions) ® | 36D. APPORTIONED TAX LIABILITY: (Multiply Line 36 by Line 36C)... 00 37. Arkansas income tax withheld: [Attach state copies of W-2 and/or 1099R Form(s)] . 38. Estimated tax paid or credit brought forward from 2015: 39. Payment made with extension: (See Instructions) E 40. AMENDED RETURNS ONLY - Previous payments: (See instructions, = 141. Early childhood program: Certification Number: 00 z (20% of federal credit; Attach federal Form 2441 and Form AR1000EC). 42. TOTAL PAYMENTS: (Add Lines 37 through 41) 00 43. AMENDED RETURNS ONLY - Previous refund: (See instructions) 00 44. Adjusted Total Payments: (Subtract Line 43 from Line 42 00 45. AMOUNT OF OVERPAYMENT/REFUND: (/f Line 44 is greater than Line 36D, enter difference, 00 46. 00 47. 00 , |48. AMOUNT TO BE REFUNDED TO YOU: (Subtract Lines 46 and 47 from Line 45) REFUND 42 —_—(00 > x DIRECT DEPOSIT? [f your deposit will be ultimately placed in a foreign account check the box. @ CL] t Routing Number Account Number e CL] Checking or 3 ° ° e LC] Savings 5 Z 49. AMOUNT DUE: (/f Line 44 is less than Line 36D, enter difference; If over $1,000, continue to 50A)....... TAX DUE 49 e/@) 00 50A. UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 50Ae[_ | Penalty 50B e 00 50C. Add Lines 49 and 50B. Attach Form AR1000V with check or money order payable in U.S. Dollars to “Dept. of Finance and Administration”. Include your SSN on payment. To pay by credit card, see instructions.............. TOTAL DUE 50Ce| 00 51. Amount of income not subject to Arkansas tax from AR4, Part Ill: (Memorandum only) May the Arkansas Revenue Agency discuss this return with the preparer of the return? ] O Yes oO No PLEASE SIGN HERE: Under penalties of perjury, | declare that | have examined this return and npanying sc! and ents, and to the best of my| knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Your Signature Date E-mail: Telephone: le Spouse’s Signature Date E-mail: Telephone: le & Paid Preparer’s Signature WD Number/Social Security Number a _ A ° ag Preparer’s Name: City/State/Zip: Telephone: ® E-mail:

Page NR2 (R 10/5/2016)

AR3

ARKANSAS INDIVIDUAL INCOME TAX ITEMIZED DEDUCTION SCHEDULE

2016

Name Social Security Number

MEDICAL AND DENTAL EXPENSES: [Do not include expense(s) paid by others]. (See Instructions) 1

Ca

3A. Multiply line 2 by 10% (.10) if you and your spouse were under 65 at the end of 2016; otherwise enter 0........3A 00 3B. Multiply line 2 by 7.5% (.075) if you or your spouse were 65 or over at the end of 2016; otherwise enter 0:....3B 00

4. TOTAL MEDICAL EXPENSES: (Subtract lines 3A and 3B from line 1; if more than line 1, enter 0) A> 00 TAXES: (See Instructions)

5. Real estate tax: 0... 00

6. Personal property tax or other taxes: (List type and amount) 6 00

7. TOTAL TAXES: (Add lines 5 and 6)... [oo INTEREST EXPENSES: (See /nstructions)

8. Home mortgage interest paid to financial institutions: 00

9. Home mortgage interest paid to an individual: Name:

Address: 9 00

10. Deductible points 00

11. Investment interest: (Attach federal Form 4952) ” 00 12. TOTAL INTEREST EXPENSE: (Add lines 8 through 11) .........cccccccccesscseseses cece eecseseseseseseseeecssscsesseesssssnetecssseesseeeeeseseneeee 12> 00 CONTRIBUTIONS: (See /nstructions) 13. Cash contributions:............... 00 14. Art and literary contributions: 00 15. Other: 00 16. Carryover contributions: (List type and amount) 00 17. TOTAL CONTRIBUTIONS: (Add lines 13 throUgh 16) .....2..:.ccccccsctscsecceccesesesesececssseseseeecseseesesseseeeceseecstessseesesseeeeeeseneeee 17> | [oo

CASUALTY AND THEFT LOSSES: (See /nstructions) 18. TOTAL CASUALTY AND THEFT LOSSES: (Aitach federal Form 4684)

POST-SECONDARY EDUCATION TUITION DEDUCTION(S): (See /nstructions) 19. TOTAL POST-SECONDARY EDUCATION TUITION DEDUCTION(S): [Attach AR1075(s)) ...

MISCELLANEOUS DEDUCTIONS SUBJECT TO 2% AGI LIMIT: (See Instructions)

20. Unreimbursed employee business expenses: (Attach federal FOr 2106)......:ccccsceeeeeeseeeeees 20 21. Other expenses: (List type and amount) 22. Add the amounts on lines 20 and 21. Enter the total: .................

23. Enter amount from Form AR1000F/AR1000NR, line 24(A) and 24(B):.... 23 [ [oo]

34. Subtract line 33 from line 29. Enter here and on Form AR1000F/AR1000NR, line 25, Column (B). |

33. Multiply line 29 by the percentage on line 32. Enter here and on Form AR1000F/AR1000NR, line 25, Col. (A):

24. Multiply line 23 above by 2% (.02):

25. 00

OTHER MISCELLANEOUS DEDUCTIONS: (See /nstructions)

26. Volunteer firefighter expense: 00

27. Other miscellaneous deductions: (List type and amount) 00

28. TOTAL MISCELLANEOUS DEDUCTIONS NOT SUBJECT TO THE 2% AGI LIMITATION: (Add lines 26 and 27).......... 28> 00

TOTAL ITEMIZED DEDUCTIONS:

29. Add amounts on Lines 4, 7, 12, 17, 18,19, 25, and 28 and enter the total NEre? oo... eccccsccssssceseseeseeseeseeseeseseeseesteseeseeseesens > 00

Complete lines 30 - 34 ONLY if Filing Status 4 or 5. YOUR SPOUSE’S

Adjusted Gross Income Adjusted Gross Income}

30. Enter adjusted gross income from Form AR1000F/AR1000NR, line 24, Columns (A) and (B) [00] 308 00

31. Total Arkansas adjusted gross income: (Add columns 30A and 30B from above) 00

32. %

00

If you and

Page AR3 (R 5/16/2016)

AR4 2016

ARKANSAS INDIVIDUAL INCOME TAX INTEREST AND DIVIDEND INCOME SCHEDULE

Name Social Security Number

Part I TAXABLE INTEREST INCOME

Interest on bank deposits, notes, mortgages from individuals, corporation bonds, savings and loan deposits, and credit union deposits are taxable. Interest on obligations of other states and subdivisions are fully taxable.

(B) (A) (Cc) NAME OF PAYER You/Joint (If Filhte Status 4) Arkansas Only

00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00

Add the amounts listed and enter the total here and on Line 10, Form AR1000F/

AR1000NR. 00 00 00

Part Il TAXABLE DIVIDEND INCOME

Dividends and other distributions on stock are fully taxable. There is no dividend exclusion applicable to Arkansas.

(B) (A) (Cc) NAME OF PAYER You/Joint (If Filhte Status 4) Arkansas Only 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 Add the amounts listed and enter the total here and on Line 11, Form AR1000F/ AR1000NR. 00 00 00 Part Il INCOME NOT SUBJECT TO ARKANSAS TAX (See Instructions on pages 10 & 11) Social Security 00 00 Railroad Retirement Benefits 00 00 Unemployment 00 00 Ministers Housing Allowance 00 00 00 00 00 00 00 00 TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on Form AR1000F/AR1000NR, Line 51) ............ 00

Page AR&4 (R 9/12/2016)

ITAD161

AR1000ADJ ih

OT 2016

ARKANSAS INDIVIDUAL INCOME TAX SCHEDULE OF ADJUSTMENTS

Name Social Security Number

INSTRUCTIONS

Full Year Resident Filers - Complete columns (A) and (8), 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 (8), 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 17 of this form and on Line 22 of AR1000F or AR1000NR.

See additional instructions on the reverse side of this form.

1) Mectnants (7) djnctments (es ajuctracnts Status 4 Only Only 1. Border city exemption: (Attach Form AR-TX).....:.sssssssssssessssssssssessseesseesseessesesesestseseesssesneess 4j@ O0}e ooje 00 2. Arkansas Tax Deferred Tuition Savings Program: (See Instructions)...........ccscceeseeeeeeeeees 2|¢ ooje ooje 00} 3. Payments to IRA: (See Instructions) .. ooje ooje 00 4. Payments to MSA: (See INStrUCtiOns) ..........scecsesseesesessesseeseessesseenessesseesessesnesnecneeeeeseeeeenees 4je ooje ooje 00 5. Payments to HSA: (Attach federal FOr 8889).......ssesesssecseeseesesseesecsesseeseestecnesseeseeeeestesneatee 5|@ ooje ooje 00 6. Deduction for interest paid on student loans: (See INStrUCtIONS)..........:.cccseeeceeeeseeseeteteeteeees hd ooje ooje 00 7. Contributions to Intergenerational Trust: (See INStrUCtIONS) ..........:cecesceseeseeeeseeteseesteteeneeeeees 7\e@ ooje ooje 00 8. Moving expenses: (Attach federal FOr 3903) ....s.sssssessessessesseessecsesseeseeseeseesesseceeeseestesnesnees 8|@ ooje ooje 00 9. Self-employed health insurance deduction: (See INStrUCtiONS) .........ecceceeeceeeeceeseeeeteeeeeees ge ooje ooje 00 10.KEOGH, Self-employed SEP and Simple Plans: .........c.ccsssssseecsessseesseesseesseeestecstesseeeseeseee 10|@ ooje oo}e 00 11. Forfeited interest penalty for premature withdrawal: ...........cccsssscsesesseseeeeceeseeeeenseeeeeeeeeeeeee 11/¢ ooje ooje 00 12. Alimony/Sep. Maint. paid to: Name: SSN: 12/¢ ooje Ooje 00 13. Support for individuals with permanent disabilities: (Attach Form AR1000DC) ...........0+++ 13/¢ Ooje Ooje 00 14. Organ Donor Deduction: (Attach Form AR1000OD).......ssssssssessesseesesseeseeseesesseeseesneeneaneenee 14|@ ooje ooje 00 15. Military Reserve Expenses: ..........ceccsceecsessesssessessecsecseesnesuecuecneesecsuesseuesuecnecnessesseeeeeneaneenee 15/¢ ooje Ooje 00 16. Reforestation Deduction: ... ooje oo}@ 00 17. TOTAL ADJUSTMENTS: (Enter here and on AR1000F/AR1000NR, Line 22) .......:.000 17\@ ooje oo0}@ 00

NOTE: Do not enter amounts from categories that are not printed on this form. See instructions for additional information.

AR1000AD4J (R 5/13/2016)

AR1000ADJ INSTRUCTIONS

LINE 1. To claim the Texarkana exemption, you must file a return and report all Arkansas income you received during the year. Attach AR-TX Form. (AR-TX Form is supplied by your employer.)

The AR-TX Form is not required for non wage income such as interest, dividends, Schedule C (sole proprietor), Schedule F (farm), Schedule E (rents, royalties, partnerships, etc.) or retirement. Additional information may be required for verification if an adjustment for these types of income is allowed.

NOTE: Taxpayers who claim this exemption must file using their street address in Texarkana, Arkansas or Texarkana, Texas. If you use a Post Office Box, this exemption will not be allowed.

If you lived within the city limits of Texarkana, Arkansas, you are allowed a full exemption from Arkansas income tax. Part year Texarkana residents claim the exemption only on income earned while a resident of Texarkana, Arkansas.

If you lived in the city limits of Texarkana, Texas, you may deduct the income you earned in the city limits of Texarkana, Arkansas. All other Arkansas income is taxable to you.

LINE 2. If you made contributions to a tuition savings account established under the Arkansas Tax Deferred Tuition Savings Program enter the amount here. Contributions to plans established in states other than Arkansas are not deductible. The deductible contribution cannot exceed $5,000 per taxpayer per tax year. Qualified withdrawals from a tuition savings account established under the Arkansas Tax Deferred Tuition Savings Program or a tax-deferred tuition savings program established by another state will be exempt from Arkansas income tax with respect to the designated beneficiary's income.

LINE 3. This line is used to report your allowable contribution to an Individual Retirement Account (IRA). If you contributed to your own IRA, certain limitations may apply to the amount you may use as an adjustment to income. If neither you nor your spouse was covered by an employer provided retirement plan, the entire contribution is deductible up to $5,500 each for all filing statuses. If either you or your spouse was covered by such a plan, the amount of the deduction depends on the amount of your Adjusted Gross Income (AGI) before the IRA deduction, as shown in the table on page 18 of the booklet. Use this table along with your Arkansas AGI to determine your allowable deduction. Catch up Contributions - Individuals who turned 50 before the close of the tax year may increase the maximum permitted annual contribution by up to $1,000.

AR1000AD4J (R 9/12/2016)

INSTRBP|

LINE 4. This line is used to report your allowable contribution to an Archer Medical Savings account (MSA). An MSA is a trust or custodial account that is created or organized exclusively for the purpose of paying the qualified medical expenses of the taxpayer (account holder) and the taxpayer’s spouse and/or dependents. To be eligible, a taxpayer must have had insurance coverage under ahigh deductible health plan (HDHP) only. AHDHP will have the following deductions and limitations: (1) for self-only coverage, the minimum deductible is $2,250, maximum deductible is $3,350 and the maximum out of pocket expense is $4,450, and (2) for family coverage, the minimum deductible is $4,450, maximum deductible is $6,700 and the maximum out of pocket expense is $8,150. The contribution limitation for any month is the amount equal to 1/12 of 65% of the annual deductible for an individual with self-only coverage and 1/12 of 75% of the annual deductible for family coverage. New Archer MSAs may not be established after 2007 but contributions can be made to existing accounts.

LINE 5. This line is used to report your allowable contribution to a Health Savings Account (HSA). To be eligible, a taxpayer must have had insurance coverage under a HDHP only. AHDHP will have the following deductions and limitations: (1) for self-only coverage, the minimum deductible is $1,300 and the maximum out of pocket expense is $6,550, and (2) for family coverage, the minimum deductible is $2,600 and the maximum out of pocket expense is $13,100. You can make pre-tax contributions of up to $3,350 each year ($6,750 for families) to cover health care costs. Individuals who reached age 55 by the end of the tax year can increase their annual contri- bution by $1,000 for 2016. Maximum contributions allowed to an HSAare reduced by any contributions made to an Archer MSA. Attach federal Form 8889.

LINE 6. You may take an adjustment for interest paid on student loans if all of the following apply:

1.You paid interest in 2016 on a qualified student loan.

2.Your filing status is any status other than married filing separately on different returns (Status 5). 3.Your AGI is less than: $80,000 if filing Status 1, 3, or 6; $160,000 if filing Status 2 or 4. Status 4 filers, note that this is a combined income amount. 4.You are not claimed as a dependent on another taxpayer’s 2016 tax return.

Figure your allowable deduction using the worksheet on page 18 of the booklet. Do not enter more than $2,500 on AR1000ADJ.

LINE 7. You may take an adjustment for contributions made to a long-term intergenerational trust. This is a trust established for an individual under age 18 to provide funds for the minor’s retirement. The trustee must be a resident of Arkansas and cannot distribute any of the trust funds to the beneficiary until the beneficiary reaches age 55. Contributions are limited to $4,000 per year.

LINE 8. Employees and self-employed persons can deduct certain moving expenses incurred in 2016.

You can take this deduction if you moved for your job or business and added at least fifty 50 miles to the distance from your old home to your workplace. If you had no former workplace, your new workplace must be at least 50 miles from your old home. (Attach a completed copy of federal Form 3903.)

If you were reimbursed for any moving expenses and the amount was included on your W-2, report this amount as income on Form AR1000F/AR1000NR, Line 8.

LINE 9. If you were self-employed and had a net profit for 2016, you may be able to deduct part of the amount paid for health insurance for yourself, your spouse, and/or dependents. Complete the worksheet on page 19 of the booklet to determine your deduction.

LINE 10. If you were self-employed and contributed to a “Keogh”, H.R. 10 retirement plan, or a SIMPLE plan, enter the total contributions. The amount of the deduction depends upon the type of plan.

LINE 11. Enter the total penalties paid for early withdrawal of certificates of deposit.

LINE 12. If you paid alimony or separate maintenance as the result of a court order, enter the total amount. Enter the name and Social Security Number of the person you paid.

LINE 13. If you have an individual with disabilities who qualifies for the deduction you can take an adjustment from income of $500 for each individual with disabilities. Attach Form AR1000DC.

LINE 14. If you paid unreimbursed expenses for yourself or one of your dependents related to the donation of an organ (part of a liver, pancreas, kidney, intestine, lung or bone marrow) you may take a tax deduction up to $10,000. The deduction must be claimed for the year in which the transplantation occurs. Allowable expenses include travel, lodging, medical expenses and lost wages related to the organ donation. An individual may claim the deduction only once in his or her lifetime. The deduction does not apply to organs harvested from a deceased donor. Attach Form AR1000-OD.

LINE 15. If you have military reserve expenses, enter the total amount.

LINE 16. If you have reforestation deductions, enter the total amount.

LINE 17. Total Adjustments. Add Lines 1 through 16 and enter on this line and on Forms AR1000F or AR1000NR, Line 22.

ITD161

AR1000D MI

ar 2016

ARKANSAS INDIVIDUAL INCOME TAX CAPITAL GAINS SCHEDULE

Name Social Security Number

For net capital gains realized from:

Jan 1, 2016 - Jun 30, 2016... Jul 1, 2016 - Dec 31, 2016...

45% is tax exempt 50% is tax exempt

Net capital gains in excess of ten million dollars ($10,000,000) per taxpayer is tax exempt.

B Federal (A) spouse (C) Schedule D You/Joint (If Filing Status 4) Arkansas Only 1. Enter federal long-term capital gain or loss reported on Line 15, federal Schedule D or Form 1040, Line 13. we 00 00 00 00 2. Enter adjustment, if any, for depreciation differences in federal and state amounts... 2 00 00 00 3. O0le O0le 00 4. 00 00 00 5. Enter adjustment, if any, for depreciation differences in federal and state amounts... 5 00 00 00 6. e 00|e 00|e (00 e 00|e 00] (00 If Line 7a (Column A or B) is more than $10,000,000, use WORKSHEET. If Line 7a is a loss skip to line 8. If Line 7a is a gain, answer questions A and B. O Yes ONo O Yes ONo O Yes ONo If NO then enter zero (0) on line 7b; if YES continue to Question B. Question B: Did transactions in Jan - June 2016 result in a net gain?....). O Yes ONo O Yes ONo O Yes ONo If NO then enter zero (0) on line 7b; if YES then enter the Jan - June net long-term capital gain on line 7b. 7b. Net long-term capital gain: Jan - June 2016 transactions only.....7b 00 00 00 7c. Enter the SMALLER of Line 7a OF 7D......-ssssssssussseseessseestinseeee ZC 00 00 00 7d. Subtract Line 7c from Line 7a... 00} 00} 00} Te. Multiply Line 7c by 55 percent (.55)........::::sssssssssssseeseeeeseeeeeneZQ 00 00 00 7f. Multiply Line 7d by 50 percent (.50) wa Tf 00} 00} 00} 8. Arkansas taxable amount (add Lines 7e and 7f, or if Line 7a is a loss enter the loss) If the WORKSHEET was used, then Line 9............ 8 00] 00] 00] 9. Enter federal short-term capital gain, if any, reported on Line 7, federal Schedule D.......: 9 00 100 100 100 10. Enter adjustment, if any, for depreciation differences in federal and state amounts... 00 00 00 11. Arkansas short-term capital gain, add (or subtract) Line 9 and Line 10 e O0}e O0}e 00} 12. Total taxable Arkansas capital gain or loss, add Lines 8 and 11. (Loss limited to $3,000, for filing status 1, 2, 3 and 6, $1,500 per taxpayer if filing status 4 or 5.) Enter here and on Line 14, AR1/NR1... 00 00 00

AR1000D (R 8/16/2016)

INDIVIDUAL CAPITAL GAINS WORKSHEET

Use this worksheet only if your capital gains are over $10,000,000. If filing status 2 AND both spouses have a gain, you MUST allocate the income earned by each spouse. If you are filing form AR1OOONR, you must use Column C to figure the Arkansas capital gains.

(A) (Cc) TAXPAYER Taxpayer Arkansas Only AR1000NR

1. Enter the total from Line 7a, FormmAR1000D If filing status 2 allocate between spouses if both have a gain. If filing status 4 and the amount on Line 1 is a loss enter that AMOUNE ON LINE Q ......essesseeeeeeeeed

Enter the net capital gain or loss from January 1, 2016 to June 30, 2016 ..................2 Enter the net capital gain or loss from July 1, 2016 to December 31, 20166 ...............3

Divide Line 2 by Line 1 and round to six decimal Places If more than 1, enter 1. Ifless than 0, enter 0.... eeseeseeustusstistinssnnsensenssnssnssssessssssesseeetansesteeseensed

5. Divide Line 3 by Line 1 and round to six decimal 1 Places. If more than 1, enter 1. Ifless than 0, enter 0.... seseeeeeneeee

Multiply Line 4 by 55 percent (.55) and round to six decimal places..... Multiply Line 5 by 50 percent (.50) and round to six decimal PlACS.......eeesssssssssssssssssesseteste Add Lines 6 and 7.....

If the amount on Line 1 is MORE than an $1006 000,000, multiply Line 8 by 6y $10, 0,000,000 and enter on Line 8, FomAR1000D.

Ifthe amount on Line 1 is LESS than $10,000,000, multiply Line 8 by Line 1 and enter

on Line 8, FormmAR1000D.

If filing status 2 add total from columns A and B Line 9, and enter on Line 8, Form

AR1000D. If using AR1OOONR, add total from columns C, Line 9 and enter on Line 8, column C. If filing status 1, 3, 4, 5, and 6, enter on Line 8, FormAR1000D. If using AR1000NR, the amount from Line 9, column C, enter on Line 8, COIUMIN C, uu... d

to bin

o @ N

(B) (Cc) SPOUSE Spouse Arkansas Only AR1000NR

1. Enter the total from Line 7a, FomAR1000D If filing status 2 allocate between spouses if both have a gain. If filing status 4 and the amount on Line 1 is a loss enter that AMOUNE ON LINE Q ......essesseeeeeeeeed

Enter the net capital gain or loss from January 1, 2016 to June 30, 2016 ..................2 Enter the net capital gain or loss from July 1, 2016 to December 31, 20166 ...............3

Divide Line 2 by Line 1 and round to six decimal places. If more than 1, enter 1. Hfless than 0, Enter 0........ccssssssscssssssecsssssesesssssseessssssesecssssssessessssssssssssssaneeess

5. Divide Line 3 by Line 1 and round to six decimal 1 Places. If more than 1, enter 1. Ifless than 0, enter 0.... seseeeeeneeee

Multiply Line 4 by 55 percent (.55) and round to six decimal places..... Multiply Line 5 by 50 percent (.50) and round to six decimal PlACS.......eeesssssssssssssssssesseteste Add Lines 6 and 7.....

If the amount on Line 1 is MORE than an $1006 000,000, multiply Line 8 by 6y $10, 0,000,000 and enter on Line 8, FomAR1000D.

Ifthe amount on Line 1 is LESS than $10,000,000, multiply Line 8 by Line 1 and enter

on Line 8, FormmAR1000D.

If filing status 2 add total from columns A and B Line 9, and enter on Line 8, Form

AR1000D. If using AR1OOONR, add total from columns C, Line 9 and enter on Line 8, column C. If filing status 1, 3, 4, 5, and 6, enter on Line 8, FormAR1000D. If using AR1000NR, the amount from Line 9, column C, enter on Line 8, COIUMIN C, ......sssescssesseeed

AR1000D Worksheet (R 9/12/2016)

o @ ND

AR1000TC

TU eg ITTC161

ARKANSAS INDIVIDUAL INCOME TAX SCHEDULE OF TAX CREDITS

2016

Primary Taxpayer Name/ Trust (Fiduciary)

Primary Social Security Number/ FEIN (Fiduciary)

IMPORTANT: SEE INSTRUCTIONS ON REVERSE SIDE OF THIS FORM

1. State Political Contribution Credit: (See instructions). 1¢@ 00 2. Other State Tax Credit: [Attach copy of other state tax return(s)]. e 00 3. Credit for Adoption Expenses: (Attach federal Form 8839) e 00 4. Phenylketonuria Disorder Credit: (See instructions. Attach AR1113) e 00 5. Business Incentive Tax Credit(s): (Add amounts from 5A-5F below) e 00 Acopy of the tax credit certificate(s) or appropriate documentation of the credit(s) claimed must be attached. If certificate is issued to an individual, leave FEIN box below blank. Primary: 5A. BIC Code |e FEIN |e Amount |e 00 5B. BICCode |e FEIN Je Amount |e 00 5C. BIC Code |e FEIN |e Amount je 00 Spouse: 5D. BIC Code |e FEIN |e Amount |e 00 5E. BiCCode |e FEIN je Amount je 00 5F. BIC Code |e FEIN |e Amount Je 00 6. TOTAL CREDITS: Add Lines 1 through 5. Enter total on Line 34, Form AR1000F/AR1000NR, or Line 23, Form AR1002/AR1002NR........... 6@ 00

BUSINESS INCENTIVE CREDIT TYPES

Code Credit Type

0001....Advantage Arkansas

ffordable Housing

R Plus.

0004....AR Plus 50% Technology-Based 0005....AR Plus 75% Technology-Based

R Plus 100% Technology-Based ‘apital Development Company

hild Care Facility

0010....Coal Mining Producing and Extracting 0011....Delta Geotourism

...Enterprise Zone

...Equipment Donation/Sale

Equity Investment Incentive ..-Existing Workforce Training ...Family Savings Initiative Act

.. Historic Rehabilitation

...Low Income Housing

ublic Roads Incentive

..-Research Park Authority

..-Research and Development with Universities ..In-House Research Income Tax Credit

Code Credit Type

0024....In-House Research by Targeted Business Income Tax Credit 0025....In-House Research Area of Strategic Value Income Tax Credit 0026....Qualified Research

0027....Rice Straw

0028....Tourism Development

0029....Tuition Reimbursement Program 0030.... Targeted Business Payroll 0031....Venture Capital Investment

0032....Youth Apprenticeship

0033....Youth Apprenticeship Work Base Learning 0034....Waste Reduction, Reuse or Recycle Equipment 0035....Water Impounded Outside Critical

0036....Water Impounded Within Critical

0037....Water Surface Outside Critical

0038....Water Surface Inside Critical

0039....Water Surface Inside Critical-Industrial or Commercial 0040....Water Land Leveling

0041....Wetland Riparian Zone Creation/Restoration 0042....Wetland Riparian Zone Conservation

0043....Central Business Improvement District Rehab and Dev 0044....Biodiesel Incentive

0045....Recycle Equipment for Steel Manufacturer

AR1000TC (R 5/13/2016)

INSTRBP|

INSTRUCTIONS FOR AR1000TC

LINE 1. Acredit of up to $50.00 per taxpayer ($100.00 for a joint return) is allowed against your Arkansas individual income tax liability for cash contributions made by the taxpayer(s) to one of the following:

(1) Acandidate seeking nomination or election to a public office or to the candidate’s campaign committee. (2) An approved political action committee as defined by Arkansas Code Annotated § 7-6-201. (3) An organized political party as defined in Arkansas Code Annotated § 7-1-101.

For the purposes of this credit, “public office” means any office created by or under the authority of the laws of the State of Arkansas, or a subdivision thereof, that is filled by the voters. The credit does not apply to contributions made to candidates for federal offices. The contribution must be made by April 15, 2017 to be claimed on the 2016 tax return.

Enter the amount of allowable State Political Contributions Credit(s) on this line. The allowable credit(s) cannot exceed $50 for Filing Status 1, 3, 5 or 6 or $100 total for Filing Status 2 or 4.

LINE 2. _ If you are an Arkansas resident and included income on your Arkansas Return that was also taxed by another state, you may claim a credit for the income tax portion of taxes paid to the other state on that income.

The income tax withheld from your wages by another state is NOT the amount of tax you owed the other state. For that reason, YOU MUST ATTACH TO YOUR ARKANSAS RETURN A SIGNED COPY OF THE TAX RETURN(S) YOU FILED WITH THE OTHER STATE(S). Enter the amount of net income tax liability to the other state(s).

NOTE: This credit cannot exceed the Arkansas income tax on the same income and cannot exceed the total tax you owe Arkansas.

Nonresidents cannot claim this credit on their Arkansas return. Part year residents will not be allowed this credit unless they continued to have taxable income from another state and the other state income is included as taxable income in Column C of Form AR1000NR.

A tax credit is allowed for a resident shareholder’s pro rata share of any net income tax paid by a Sub S Corporation to a state that does not recognize Sub S Corporation status.

The State of Mississippi enacted a special tax that applies exclusively to gambling winnings. This tax is separate and distinct from Mississippi's income tax. As such, an Arkansas taxpayer cannot claim a credit against their Arkansas income tax liability for payment of the gambling winnings tax to the State of Mississippi.

LINE 3. The Adoption Expense Credit allowed is twenty percent (20%) of the amount allowed on your federal return. A copy of federal Form 8839 must be attached to your Arkansas return.

LINE 4. Enter the allowable Phenylketonuria Disorder Credit. Attach Form AR1113.

LINE 5. Enter the total allowable credit(s) claimed. Enter the BIC Code(s) and amount(s) on Lines 5A to 5F. If the primary and/or spouse are claiming credits earned by a pass-through entity, then the FEIN of that entity must also be entered. Enter the total amounts from Lines 5A to 5F in box 5. A copy of the tax credit certificate(s) or appropriate documentation relevant to the tax credit(s) claimed must be attached to AR1000TC.

NOTE: Recent legislation may have amended, increased, or extended some of the provisions for Business Incentive Credits. Use of any credit is subject to the limitations and carryover provisions provided by the respective Arkansas statute. Asummary of the Business Incentive Credit Programs can be found at www.dfa.arkansas.gov. If you have questions, please contact the Tax Credits/Special Refunds Section at (501) 682-7106.

LINE 6. Enter total on Line 34, Form AR1000F/AR1000NR, or Line 23, Form AR1002/AR1002NR.

AR1000TC (R 7/12/2016)

AR1000-CO ih

een a 2016

ITCO161

ARKANSAS INDIVIDUAL INCOME TAX SCHEDULE OF CHECK-OFF CONTRIBUTIONS

NAME SSN

SPOUSE’S NAME SSN

ADDRESS

CITY STATE ZIP

SEE INSTRUCTIONS ON REVERSE SIDE OF THIS FORM

4. ARKANSAS DISASTER RELIEF PROGRAM ..00..00.0.0.0..ccccccscsssssssssssssssssssssssesssssssssssssseseeee {3 List [CJs5 ([is1i0 LJs2 CJ — (_] Your Total Refund

2. ARKANSAS GAME AND FISH FOUNDATION 0 ccscccsvveeererseroenecee - {3 Lis L]$5 Ls10 Oo [1] Your Total Refund

3. ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF... -|s LJ s$1 L]$5 L]$10 C] _ _] Your Total Refund

4. BABY SHARON’S CHILDREN’S CATASTROPHIC ILLNESS PROGRAM... -|s Lls1 CJs5 (Cisio [4320 [] —_ _] Your Total Refund

5. ORGAN DONOR AWARENESS EDUCATION PROGRAM cusssssssssssessessesestisisitisiuniesesessen - {3 Osi (Liss Ois10 Oo (1 Your Total Refund

6. AREA AGENCIES ON AGING PROGRAM ............. : a cessssssesessesseseststussuusiiinsnssssssseseseeee - {3 Ls L]s5 Os10 OJ __ (1) Your Total Refund

7. MILITARY FAMILY RELIEF PROGRAM. ................. vie -|s List (Clss (Clsto CJs2o CJ — _] Your Total Refund

8. NEWBORN UMBILICAL CORD BLOOD INITIATIVE oc cceecceseseeee -|s List (Clss (Clsto CJs2o CJ _] Your Total Refund

Enter Amount

9. ARKANSAS TAX DEFERRED TUITION SAVINGS PROGRAM

IMPORTANT: To contribute to your Arkansas Tax Deferred Tuition Savings Program, you MUST enter the account number below. You may contribute part or all of your refund to one or two accounts, provided a minimum of $25 is contributed to each account. (You cannot send a check for this check-off.)

CHOOSE ACCOUNT TYPE: ([_|GIFT [_]iShares.... we @ 1S []$25 L_] $50 [] $100 CT _] Your Total Refund Enter Amount Account Number CHOOSE ACCOUNT TYPE: [_|GIFT — [_]| iShares... cece e | []$25 L_] $50 1 $100 Cc _] Your Total Refund

Enter Amount

Account Number

10. TOTAL CHECK-OFF CONTRIBUTIONS ooo. cece cece eetee seen seesesseseeeeteeteeegs $

AR1000-CO (R 5/31/2016)

INSTRBP|

INSTRUCTIONS FOR AR1000-CO

GENERAL INSTRUCTIONS:

Check the appropriate box and enter the designated amount for each check-off contribution in the box provided. Total your contributions and enter the amount in Box 10. Contributions are limited to whole dollar amounts only.

FOR TAXPAYERS WHO ARE DUE A REFUND:

Attach this schedule to any return claiming a check-off contribution. Enter the amount in Box 10 on Line 47 of Form AR1000F/AR1000NR or Line 27 of Form AR1000S. The total amount you contribute will reduce your refund by a corresponding amount.

If this schedule is not attached to your return or if the amount in Box 10 is not entered on your return, your contribution will not be recognized and the amount will be refunded to you.

FOR TAXPAYERS WHO OWE ADDITIONAL TAXES:

Detach this schedule and submit a separate check for the total amount of your check-off contributions. (You can send a check for check-off contributions #1 through #8. You cannot send a check for check-off contribution #9.) Mail to: Arkansas Individual Income Tax, P.O. Box 3628, Little Rock, AR 72203.

FOR INFORMATION ABOUT PROGRAMS/ORGANIZATIONS ON AR1000-CO GO TO:

1. Arkansas Disaster Relief Program: www.adem.arkansas.gov

2. Arkansas Game and Fish Foundation: www.agff.org

3. Arkansas School for the Blind: www.arkansasschoolfortheblind.org

Arkansas School for the Deaf: www.arschoolforthedeaf.org

4. Baby Sharon’s Children’s Catastrophic Illness Program: www.babysharonfund.arkansas.gov

5. Organ Donor Awareness Education Program: www.arora.org

6. Area Agencies on Aging Program: www.daas.ar.gov/aaamap.html

7. Military Family Relief Program: www.arguard.org/Family/docs/MFRTF.pdf

8. Newborn Umbilical Cord Blood Initiative: www.cordbloodbankarkansas.org/

9. Arkansas Tax Deferred Tuition Savings Program: www.arkansas529.org

AR1000-CO Instr. (R 5/13/2016)

Ga. State of Arkansas

Avs: fay Department of Finance and Administration a vad | Sales and Use Tax Section oe es Sto CONSUMER USE TAX FORM

If you purchased taxable merchandise outside the State of Arkansas for use, storage, consumption or distribution within the state, a state and local consumer use tax may be due on the purchase price, including transportation charges. Due to the rapid increase in purchases being made through mail order, telephone, and the Internet, it has become a concern that individuals may not be aware of their obligation to report the consumer use tax on untaxed out of state purchases. Examples of merchandise subject to the consumer use tax include cas- settes, CD’s, books, furniture, jewelry, food, and clothing.

The use tax is a companion tax to the sales tax whose purpose is to not only raise revenue for the state, but more importantly to protect local merchants, who must collect sales tax, from the unfair advantage of out of state sellers who do not collect Arkansas’s sales tax. The use tax has been in effect since 1949.

The use tax rate is the same as the sales tax rate, 6.50% for all transactions except food purchases which has a reduced rate of 1.5% plus the applicable city and/or county rates where the merchandise is delivered in the state. The tax applies to the purchase price of the merchandise plus any shipping and handling charges that the merchant adds to your bill. If the total tax due is greater than $100 per month, the use tax report should be filed on a monthly basis. If the total tax due is $25 - $100 per month, the use tax report should be filed on a quarterly basis. If the total tax due is less than $25 per month, the use tax report should be filed on an annual basis.

Line 1 Indicate the month and year you are reporting. (mm/yyyy) Report all taxable purchases except food in Column A, food purchases are reported in Column B. Line 3 Fill in the County Rate where you reside (Column A and/or Column B) Line 4 Fill in the City rate where you reside. (Column A and/or Column B) Line 5 Enter total rate - the sum of lines 2 through 4. (Column A and/or Column B) Line 6 Enter total purchases (column A is for all items except food) (column B is for Food only) Line 7 Enter your total tax rate from line 5 Line 8 Multiply line 7 by line 6 and enter the product. Line 9 Add lines 8A and 8B and enter the total. (This is the TOTAL tax to remit with this report.)

If you have questions or need additional forms, please call the Sales and Use Tax Office at (501) 682-7104.

Individual Consumer Use Tax Report | 1. Report Period >

A B Arkansas Department of Finance and Administration General State Reduced Food Sales and Use Tax Section Tax Tax P. O. Box 8054, Little Rock, AR 72203 2. State Rate 6.500% 1.500% 3. County Rate + Purchaser(s): 4. City Rate + Social Security Number: 5. Total Tax Rate = Home Address: 6. Purchases $ 7. Total Tax Rate 8. Total Tax $ City/State/Zip:

Phone Number: 9. TOTAL Tax Due ss.

County of Residence:

Check here if this is an aviation purchase > [] (Attach a copy of the bill of sale)

If you live outside the city limits check here > ” ¥ LI City and county rate may be obtained from our website.

If you live in a city other than what is shown in your mailing | ttp:/Avww.state.ar.us/salestax address above, please indicate that city here and use that tax | °F by calling (501) 682-7104 rate to compute your tax

CU-1 (R 07/2013)

Individual Consumer Use Tax Report | 1. Report Period >

A B Arkansas Department of Finance and Administration General State Reduced Food Sales and Use Tax Section Tax Tax P. O. Box 8054, Little Rock, AR 72203 2. State Rate 6.500% 1.500% 3. County Rate + Purchaser(s): 4. City Rate + Social Security Number: 5. Total Tax Rate = Home Address: Purchases $ 7. Total Tax Rate - - 8. Total Tax $ City/State/Zip:

Phone Number: 9. TOTAL Tax Due CS |

County of Residence:

Check here if this is an aviation purchase > [| (Attach a copy of the bill of sale)

If you live outside the city limits check here > y y LI City and county rate may be obtained from our website.

If you live in a city other than what is shown in your mailing | http-//www.state.ar.us/salestax address above, please indicate that city here and use that tax | °F by calling (501) 682-7104 rate to compute your tax

State of Arkansas Department of Finance and Administration Sales and Use Tax Section

CONSUMER USE TAX FORM

If you purchased taxable merchandise outside the State of Arkansas for use, storage, consumption or distribution within the state, a state and local consumer use tax may be due on the purchase price, including transportation charges. Due to the rapid increase in purchases being made through mail order, telephone, and the Internet, it has become a concern that individuals may not be aware of their obligation to report the consumer use tax on untaxed out of state purchases. Examples of merchandise subject to the consumer use tax include cas- settes, CD’s, books, furniture, jewelry, food, and clothing.

The use tax is a companion tax to the sales tax whose purpose is to not only raise revenue for the state, but more importantly to protect local merchants, who must collect sales tax, from the unfair advantage of out of state sellers who do not collect Arkansas’s sales tax. The use tax has been in effect since 1949.

The use tax rate is the same as the sales tax rate, 6.50% for all transactions except food purchases which has a reduced rate of 1.5% plus the applicable city and/or county rates where the merchandise is delivered in the state. The tax applies to the purchase price of the merchandise plus any shipping and handling charges that the merchant adds to your bill. If the total tax due is greater than $100 per month, the use tax report should be filed on a monthly basis. If the total tax due is $25 - $100 per month, the use tax report should be filed on a quarterly basis. If the total tax due is less than $25 per month, the use tax report should be filed on an annual basis.

Line 1 Indicate the month and year you are reporting. (mm/yyyy) Report all taxable purchases except food in Column A, food purchases are reported in Column B. Line 3 Fill in the County Rate where you reside (Column A and/or Column B) Line 4 Fill in the City rate where you reside. (Column A and/or Column B) Line 5 Enter total rate - the sum of lines 2 through 4. (Column A and/or Column B) Line 6 Enter total purchases (column A is for all items except food) (column B is for Food only) Line 7 Enter your total tax rate from line 5 Line 8 Multiply line 7 by line 6 and enter the product. Line 9 Add lines 8A and 8B and enter the total. (This is the TOTAL tax to remit with this report.)

If you have questions or need additional forms, please call the Sales and Use Tax Office at (501) 682-7104. CU-2 (R 07/2013)

PLEASE PRINT AND USE BLACK INK TO COMPLETE

Rev. 7/12

ARKANSAS VOTER REGI

STRATION APPLICATION

Check all that appl: This is a new registration. This is a name change.

an address change.

Office Use Only

jis is a party change. [assigned ed Last Name Jr. Sr. | First Name Middle Name 1 Miss Ms. WML IV. Address Where You Live (See Section “C” Below) Apt. or Lot #| City/Town County State | Zip Code 2 (Rural addresses must draw map.) Address Where You Receive Mail If Different From Above Apt. or Lot #| City/Town County State | Zip Code 4. | bate of Birth ji ji 5 Home & Work Phone Numbers (Optional) 6 Party Affiliation (Optional) ate of Bil Month Day Year (H) () 7 E-mail Address (Optional) 8 [Have you ever voted in a federal election in this State? O Yes O No ID Number - Check the applicable box and provide the appropriate number. Signature of elector - Please sign full name or put mark. 00 Arkansas Driver’s license number 9 0 If you do not have a driver’s license provide the last 4 digits of social security number 01 [have neither a driver's license nor social security number. (A) Are you a citizen of the United States of America and an Arkansas resident? OYes [INo = — =. = (B) Will you be eighteen (18) years of age or older on or before election day? The information | have provided is true to the best of my knowledge. | do not claim the right to O ves No . vote in another county or state. If | have provided false information, | may be subject to a fine (C) Are you presently adjudged mentally incompetent by a court of competent of up to $10,000 and/or imprisonment of up to 10 years under state and federal laws. jurisdiction? 10 O Yes OINo Date: | I (D) Have you ever been convicted of a felony without your sentence having been Month Day Year cpcharged aac? 11 If applicant is unable to sign his/her name, provide name, address es lo and phone number of the person providing assistance: If you checked No in response to either questions A or B, do not complete this form. Name: Address: If you checked Yes in response to either questions C or D, do not complete this form City: State: Phone#:

Please complete the sections below if: + You were previously registered in another county or state, or

MAIL REGISTRANTS: PLEASE SEE SECTION D.

Agency Code (For Official Use Only)

+ You wish to change the name or address on your current registration.

Mr. Previous Last Name Jr. Sr. | First Name Middle Name(s)

Mrs. A Miss

Ms. WML IV. Date of Birth I /

Month Day Year Previous House Number and Street Name Apt. or Lot # | City or Town State Zip Code B If you live in a rural area but do not have a house or street number, or if

you have no address, please show on the

map where you live.

+ Write in the names of the crossroads (or streets) nearest where you live. + Draw an “X” to show where you live.

Cc + Use a dot to show any schools, churches, stores or other landmarks near where you live and write the name of the landmark. Example

+ Grocery Store

; IDENTIFICATION REQUIREMENTS

IMPORTANT: If your voter registration application form is submitted by mail and you are registering for the first time, and you do not have a valid Arkansas driver’s license wort f number or social security number, in order to avoid the

additional identification requirements upon voting for the

first time you must submit with the mailed registration form:

Woodchuck Road

(a) a current and valid photo identification; or (b) a copy|

Route #2

+ Public School

X

of a current utility bill, bank statement, government check, paycheck, or other government document that shows your} name and address.

Deadline Information

To qualify to vote in the next election, you must apply to register to vote 30 days before the election. If you mail this form, it must be postmarked by that date. You may also present it to a voter registration agency representative by that date. If you miss the deadline you will not be registered in time to vote in that election. Please don’t delay. Make sure your vote counts.

If you are qualified and the information on your form is complete, you will be notified of your voting precinct by your local

County Clerk. Mail the completed form to:

Arkansas Secretary of State ATTN: Voter Registration P. O. Box 8111 Little Rock, 72203-8111

Questions? Call your local County Clerk or Arkansas Secretary of State Mark Martin Elections Division - Voter Services 1-800-482-1127

Contact your County Clerk if you have not received confirmation of this application within two weeks

REFUND OR TAX DUE

LINE 45. If Line 44 is more than Line 36 on Form AR1000F or Line 36D on Form AR1000NR, you overpaid your tax. Write the difference here. If you want a refund only, skip Lines 46 and 47 and enter the amount of your refund on Line 48.

LINE 46. You can apply part or all of the tax you OVERPAID in 2016 to your tax in 2017. Enter the amount you would like to have carried forward. The overpayment will be applied directly to your 2017 estimated account. If you wish to apply only part of Line 45 to pay 2017 tax, you will be issued a refund for the balance of your overpayment.

NOTE: The amount you carry over to pay 2017 taxes will only be credited to the primary filer. /t cannot be divided between the primary filer and spouse.

LINE 47. If you wish to contribute a portion or all of your overpayment to one or more of the programs listed below, complete Schedule AR1000- CO and enter total amount of your donation. Attach Schedule AR1000-CO after Form AR1000F/AR1000NR.

Area Agencies on Aging Program

Arkansas Disaster Relief Program

Arkansas Game and Fish Foundation

Arkansas Schools for the Blind and Deaf Arkansas Tax Deferred Tuition Savings Program Baby Sharon's Children’s Catastrophic Illness Program Military Family Relief Program

Newborn Umbilical Cord Blood Initiative

Organ Donor Awareness Education Program

LINE 48. Subtract Lines 46 and 47 from Line 45. This is the amount of your REFUND.

Get your refund faster with direct deposit. For direct deposit to your checking or savings account, you must enter your routing and account numbers and check the box for either checking or savings. If you checked the box ultimately placing your direct deposit into a foreign account, stop here. Direct deposits will not be deposited into accounts outside the United States; this includes Puerto Rico, Guam and the Virgin Islands.

The State of Arkansas is not responsible for the misapplication of a direct deposit that results from error, negligence or malfeasance on the part of the taxpayer, the provider or preparer, financial institution or any of their agents.

Check your form carefully, since any error could prevent your bank from accepting your direct deposit. Refunds that are not direct deposited because of Institutional refusal, erroneous account or routing transit numbers, closed accounts, bank mergers or any other reason are issued as paper checks. While the State of Arkansas ordinarily processes a request for direct deposit, it reserves the right to issue a paper check and does not guarantee a specific date for deposit of the refund into the taxpayer’s account.

The Director is allowed 90 days from the return due date or the date the return was filed, whichever occurs later, to refund an overpayment of tax without interest (Act 262 of 2005).

SET OFF REFUNDS

If you, your spouse, or former spouse owes a debt to one of the agencies below, all or part of your refund is subject to being withheld to satisfy the debt. You will receive a letter advising which agency has claimed your refund.

Any housing authority

Arkansas circuit, county, district, or city courts AR colleges, universities, and technical institutes Arkansas Highway and Transportation Dept. Arkansas Public Defender Commission Arkansas Real Estate Commission

County tax collectors or treasurers Department of Finance and Administration Department of Health

Department of Higher Education

Department of Human Services

Employee Benefits Division of DFA

Internal Revenue Service

Office of Child Support Enforcement

Office of Personnel Management of DFA

It is the agency’s responsibility to refund any set off amount paid to the agency in error.

If you owe a debt for Arkansas income tax, your federal refund may be captured to satisfy your state income tax debt.

NOTICE TO MARRIED TAXPAYERS:

If only one of the married taxpayers owes the debt, the taxpayer who is not liable can avoid having his/her refund applied to the debt if both taxpayers file Status 5, Married Filing Separately on Different Returns.

LINE 49. If Line 36 of Form AR1000F or Line 36D of Form AR1000NR is more than Line 44, you owe additional tax. Subtract Line 44 from Line 36 of Form AR1000F or Line 36D of Form AR1000NR. Enter amount here. This is the TAX YOU OWE.

LINE 50A and 50B. UNDERESTIMATE PENALTY: If required enter the exception number from Part 3 of the AR2210, or the computed penalty from Line 18 of AR2210 in the appropriate box. If you completed AR2210A, enter “6” in box 50A. Enter amount from Line 46 of AR2210A in box 50B.

Form AR2210 or AR2210A must be attached and the exception number entered in box 50A. to claim any exclusion from the Underestimate Penalty.

LINE 50C. Add Lines 49 and 50B. Enter total on this line.

LINE 51. Enter the total amount from Form AR4, Part Ill in the space provided.

Your tax return will not be legal and cannot be processed unless you SIGN IT.

Write in the DATE. If you and your spouse are filing a joint tax return or filing separately on the same return, both of you must sign it.

If someone else prepares your return, that person must sign and complete the Paid Preparer section. If you prepare your own return, DO NOT use this section.

PAYMENT INFORMATION

Complete Form AR1000V (available at www. dfa.arkansas.gov) and attach a check or money order to your return. Write the tax year and your Social Security Number or account number on the check or money order, and make your check payable in U.S. Dollars to the Department of Finance and Administration. Mail on or before April 15, 2017. If the payment is for an amended return, mark the box yes on Form AR1000V for “Is Payment for an Amended Return”.

Credit card payments may be made by calling 1-800-2PAY-TAX*" (1-800-272-9829), or by visiting www.officialpayments.com and clicking on the “Payment Center’ link.

Credit card payments will be processed by Official Payments Corporation, a private credit card payment services provider. A convenience fee will be charged to your credit card for the use of this service. The State of Arkansas does not receive this fee. You will be informed of the exact amount of the fee before you complete your transaction. After you complete your transaction you will be given a confirmation number to keep with your records.

NOTE: Do not send currency or coin by mail.

yPTCEAL PAYMENTS Con, c 2

VISA

PENALTIES & INTEREST

You must mail your tax return by April 15, 2017. Any return not postmarked by April 15, 2017 (unless you have an extension) will be delinquent. A penalty of one percent (1%) per month for failure to pay and five percent (5%) per month for failure to file, up to a maximum of thirty-five percent (35%), will be assessed on the amount of tax due on an original return. Interest of ten percent (10%) per year will also be assessed on any additional tax due, calculated from the original due date to the date you paid the tax due on an original or amended return.

An extension to file is not an extension to pay. If you have not paid the amount due by the original due date you will be subject to a failure to pay penalty of one percent (1%) per month of the unpaid balance.

In addition to any other penalties assessed, a penalty of $500 will be assessed, if any taxpayer files what purports to be a return, but the return does not contain information on which the correctness of the return may be judged, and such conduct is due to a position which is frivolous or an effort to delay or impede the administration of any State law.

Page 15

ITEMIZED DEDUCTIONS INSTRUCTIONS (FORM AR3)

MEDICAL AND DENTAL EXPENSES

List only amounts you paid and for which you were not reimbursed.

LINE 1. Enter total medical and dental expenses, less reimbursements from insurance or other sources. See chart on Page 17 for examples of deductible and nondeductible expenses.

LINE 2. Enter total amount from Form AR1000F/ AR‘1000NR, Lines 24A and 24B.

LINE 3A. If you and your spouse were under the age of 65 at the end of 2016, multiply Line 2 by 10% (.10). Otherwise enter zero (0).

LINE 3B. If either you or your spouse were age 65 or over at the end of 2016, multiply Line 2 by 7.5% (.075). Otherwise enter zero (0)

LINE 4. Subtract Lines 3A and 3B from Line 1.

TAXES

LINE 5. You may deduct real estate taxes you paid on property you own that was not used for business. Do not include any special assessments or levy taxes.

Some taxes you cannot deduct are:

Arkansas income taxes

Car tags

Cigarette and beverage taxes Dog licenses

Estate taxes

Federal income taxes Federal Social Security taxes Hunting and fishing licenses Improvement taxes

Sales taxes

LINE 6. Taxes you may deduct on this line: City income taxes Mississippi gambling taxes Personal property taxes

Taxes paid to a foreign country on income taxed on this return

LINE 7. Add the amounts on Lines 5 and 6.

Page 16

INTEREST EXPENSE

LINE 8. You may deduct the home mortgage interest paid to a bank or other financial institution.

The deduction is generally limited to interest attributable to a debt for not more than the cost of the principal, and/or second residence, plus improvements.

LINE 9. Deduct home mortgage interest paid to an individual on this line, and list that person’s name and address.

LINE 10. Enter the amount of deductible points paid on this line. Deductible points are those that:

1. Are incurred in the purchase or improvement of the taxpayer's principal residence; and

2. Reflect an established business practice of charging points in the geographical area where the loan is made; and

3. Donot exceed the number of points generally charged for the type of transaction. (Points paid in refinancing a mortgage must be amortized over the life of the loan.)

NOTE: /n order to deduct the full amount of the points paid, payment of the points must be made from separate funds brought to the loan closing.

LINE 11. Enter deductible investment

interest. The deduction is limited to the amount of investment income. Interest that is disallowed because of the limitation can be carried forward to the next year and deducted to the extent of the limitation in the carryover year. Attach federal Form 4952.

LINE 12. Add Lines 8, 9, 10, and 11.

CONTRIBUTIONS

LINE 13. Enter the total contributions you made by cash or check. If you gave $3,000 or more to any one organization, list the donee and amount given. If you have non-cash contributions of $500 or more, attach federal Form 8283.

LINE 14. In addition to other contributions, a deduction is allowed for the donated value of artistic, literary, and musical creations if the following qualifications are met:

1. The taxpayer making the donation derived at least fifty percent (50%) of his/her current or prior year income from an art related profession;

2. The fair market value of the art work has been verified by an approved independent appraiser, and a copy of the appraisal is attached;

3. The artwork was donated to a museum, art gallery, or nonprofit charitable organization qualified under Internal Revenue Code § 501(C)(3) and located in the State of Arkansas; and

4. The deduction for donated art work does not exceed fifteen percent (15%) of the donor’s gross income in the calendar year of donation.

LINE 15. List other deductible contributions:

1. _Unreimbursed amounts spent to maintain an elementary or high school student (other than a dependent or relative) in a taxpayer’s home under a program sponsored by a charitable organization.

2. Agift of property to a non-profit organization. Attach a description of the property, date of gift, and method of valuation. For each gift in excess of $500, list any conditions attached to the gift, manner of acquisition, and cost or basis if owned by you for less than five (5) years.

NOTE: Payments to private academies or other

schools for the education of dependents

are not deductible as contributions.

LINE 16. If you made contributions in excess of fifty percent (50%) of your adjusted gross income, you may carry the excess deduction over for a period of five (5) years.

If you are deducting an excess contribution from a previous year, enter the amount and year of the original contribution.

LINE 17. Add lines 13, 14, 15, and 16.

CASUALTY AND THEFT LOSSES

LINE 18. The method of computing casualty or theft losses is the same as the federal method with the $100 exclusion. The amount of each loss must exceed ten percent (10%) of your adjusted gross income. Attach federal Form 4684 and provide necessary supporting documents.

If you have a Disaster Loss in 2017 on property in a federal disaster area, you may elect to deduct the loss as an itemized deduction in 2016. If you elect to report the loss on your 2016 return, you cannot report the loss on your 2017 return.

A disaster loss is the only loss which may be carried back. You may amend your 2015 return to report a disaster loss incurred in 2016. If you elect to amend your 2015 return, you cannot report the loss on your 2016 return. If loss in federal disaster area, list location on Line 18.

LINE 19. Enter your Post-Secondary Education Tuition Deduction and attach Form AR1075(s).

MISCELLANEOUS DEDUCTIONS SUBJECT TO THE 2% AGI LIMITATION

LINE 20. Enter unreimbursed employee business expenses. Arkansas recognizes the federal mileage allowance for computing business travel expenses. Attach federal Form 2106.

LINE 21. Other deductions include:

Union or professional dues

Tax return preparation fees Expenses for safety equipment Expenses of entertaining customers Tools and supplies

Fees paid to employment agencies

Attach supporting schedule or statement.

LINE 22. Add Lines 20 and 21.

LINE 23. Enter combined amount from Form AR1000F/AR1000NR, Lines 24A and 24B.

LINE 24. Multiply Line 23 by 2% (.02).

LINE 25. Subtract Line 24 from Line 22. This is your total allowable miscellaneous deductions.

OTHER MISCELLANEOUS DEDUCTIONS

LINE 26. Volunteer firefighters may deduct unreimbursed expenses of firefighting equipment required by the volunteer fire department and/ or loss of value of personal property damaged or destroyed during volunteer firefighting activities. To qualify, you must have received less than $5,000 total compensation for the taxable year from the volunteer fire department you served. This deduction may not exceed $1,000 per volunteer firefighter.

LINE 27. Enter your other miscellaneous deductions not subject to the 2% AGI limit. Attach detailed schedule of each deduction.

LINE 28. Add Lines 26 and 27.

LINE 29. Add Lines 4,7,12,17,18,19, 25 and 28.

PRORATED ITEMIZED DEDUCTIONS

LINE 30. If you are married filing separately, Status 4 or 5, you must prorate your itemized deductions between spouses. Enter your AGI from Line 24, Column A and your spouse’s AGI from Line 24, Column B of Form AR1000F/AR1000NR.

LINE 31. Add Lines 30A and 30B.

LINE 32. Divide Line 30A by Line 31 and enter the percentage here. Round to the nearest whole percent.

LINE 33. Multiply the total itemized deductions reported on Line 29 by your percentage on Line 32. Enter result here and on Form AR1000F/ AR1000NR, Line 25, Column A.

LINE 34. Subtract Line 33 from Line 29. Enter result here and on Form AR1000F/AR1000NR, Line 25, Column B. If you and your spouse are using Filing Status 5, this is the amount of the total itemized deductions your spouse is allowed to claim on his/her tax return.

Deductible

Deductible vs. Non-deductible

Medical Expenses The chart below lists specific types of expenses and whether or not a deduction for the ex- pense is permitted.

Non-deductible

Alcoholism, treatment of

Ambulance hire

Attendant to accompany blind or deaf student

Chiropractor

Contact lenses

Contraceptives, prescription

Dental fees

Drug addiction, recovery from

Drugs, prescription

Eye examinations and glasses

Hearing aids

Insulin

Laser eye surgery

Long-term care expenses

Orthopedic shoes

Psychiatric care

Psychologist

Smoking, program to stop

Wheelchair

X-rays

Anticipated medical expenses

Baby-sitting expenses to enable parent to see doctor

Cosmetic surgery, unnecessary

Diaper service

Ear piercing

Electrolysis

Funeral expenses

Gravestone

Hair transplants, surgical

Health club dues

Hygienic supplies

Insurance premiums-loss of income

Insurance premiums-loss of limb

Marriage counseling

Maternity clothes

Spiritual guidance

Tattoos

Teeth, whitening

Toilet articles

Trips, general health improvement

Page 17

STUDENT LOAN INTEREST WORKSHEET

1.

2 3. 4

9.

10.

Enter the total interest you paid in 2016 on qualified student loans ..0..... eee eeeeeeeeereeees 1 Enter the smaller of Line 1 above Or $2,500. ........c.ccccceccesscesccesceeecesceesccseseseceuseseeeseceusesaveressase 2

Enter the amount(s) from Form AR1000F/AR1000NR, Line(s) 21A and 21B

Enter total adjustments from Form AR1000F/AR1000NR, Line(s) 22A and 22B. (Do not include the deduction for interest paid on student loans, Line 6, AR1000ADVJ.).....4

Modified AGI. Subtract Line 4 from Line 3 o.oo... ee cece eeeeeeceeeteeeeeeeeeeteseeeseeeeaeenaeeneseeeeaneaee 5

Note: If line 5 is $80,000 or more and you are filing Status 1, 3, or 6 or $160,000 or more

and you are filing Status 2 or 4, STOP HERE. You cannot take the deduction. Enter: $65,000 if filing Status 1, 3, or 6; $130,000 if filing Status 2 or 4...

Subtract Line 6 from Line 5. If zero or less, enter -0- here and on Line 9, skip Line 8, and go to Line 10.0... 7

Divide Line 7 by $15,000 ($30,000 if filing status 2 or 4). Enter result as a decimal (rounded to at least three places). .......e ec eceseeeeeeteeteeteeteeeeeees 8

Multiply Line 2 by Line 8 oo... eee ee cee eeeeeeeeeeteeeeeeeeeeteeeseeeseeseeesaeeseesaeeseeeeeesaeesaesneeteeeeaeenee 9

Allowable Deduction: Subtract Line 9 from Line 2. Enter result here and on Form AR1QOOADV, Line 6................ccccc cece ceccessseeeesesssaeeeeenes 10

FILING STATUS 4 ONLY

11.

12. 13.

14.

15.

IRA PHASE OUT CHART

YOUR ALLOWABLE TRADITIONAL IRA DEDUCTION

Enter the total interest for each spouse

up to the combined amount on Line 1 oo... eee eee eee eeetereteees 1A 11B

Spouse

Total amount paid from Line 1... ee ee cece eeeeeeeteeeeeeeeeeeeeeeeeeneees 12

Divide Line 11A by Line 12. Enter result as a decimal (rounded to at least three places) ......... 13

Multiply Line 10 by the amount on Line 13. Enter here and on AR1000ADJV, Line 6, Column A..................... 14

Subtract Line 14 from Line 10. Enter here and on AR1000ADJV, Line 6, Column B.......... 15

IF YOUR FILING STATUS IS: Phases out when Will be zero when Arkansas AGI exceeds: Arkansas AGI is: Single, Head of Household $61,000 $71,000 Married Filing on Same Return (Status 2 or 4), lor Qualifying Widow(er) $98,000 $118,000 Married Filing on Separate Returns (Status 5) $0 $10,000 Nonactive Spouse (Income Computed Jointly) $184,000 $194,000

If your Arkansas AGI is within one of the above phaseout ranges, see IRS Publication 590 to figure

your allowable IRA deduction.

Page 18

SELF-EMPLOYED HEALTH INSURANCE DEDUCTION WORKSHEET

1. Enter the total amount paid in 2016 for health insurance coverage established under

your business for 2016 for you, your spouse, and your dependent. ............:eceeeseeeeeeeeeseeeeereeeeenee 1 2. Enter your net profit and any other earned income* from the business under which the

insurance plan was established, less any deductions on Form AR1000ADJ, Line 10.............. 2 3. Enter the smaller of Line 1 or Line 2 here and on Form AR1000ADJ, Line 9. (Do not include

this amount in figuring your medical expense deduction on the Itemized Deduction Schedule.).......... 3

*Eamed income includes net earnings and gains from the sale, transfer, or licensing of property you created. It does not include capital gain income. If you were more than a 2% shareholder in an S corporation, earned income is your wages from that corporation.

MILEAGE AND DEPLETION ALLOWANCES

Mileage Allowance

BUSINESS... eee eeeeeeeete eee eeeeeeeeee 54 cents/mile Charitable... eeeceeeeeeeeeeeeeee 14 cents/mile Medical/Moving .........:::seeeeeeee 19 cents/mile

Mail Carrier (rural)... Reimbursement received

Depletion Allowance Depletion (gas and oil) Same as federal

(15% for most gas and oil production)

DEPRECIATION INFORMATION

Section 179 Facts

Arkansas adopted IRC §179 as in effect on January 1, 2009, allowing greater dollar limits and phase out thresholds.

> Deduction Limit — $25,000 > Cost of qualifying property limit - $200,000

> No deduction allowed above $225,000

> More than one property placed in service — limit $25,000 deduction per taxpayer per year > Any cost not deducted in one year may be carried forward to next year

> Deduction may not be used to reduce taxable income below zero

Note: Arkansas has not yet adopted the most recent federal changes.

HOW TO FILL OUT YOUR CHECK

Make your check payable to "Dept. Date and mail payment on

of Finance and Administration". or before April 15th, 2017. Lynne Taxpayer y 3169 2222 Austin Ave Tony, AR 11122 Date_April 15, 2017 Phone (501) 555-1552 PAY TO THE ORDER OF: Dept. of Finance and Administration a|$___ 125.00

Oue hundred five aud uo/100 poate Tax year 2016 MEMO: 12345678-T Lynne Taspayer A LN Make sure both amounts match Include your Account ID or Social Security Don't forget to sign your check!

Number and the tax year on the memo line.

Page 19

FOR TAXPAYERS’ INFORMATION

Individual and corporation income taxes are the largest source of state general revenue.

$6,580.8 MILLION GENERAL REVENUE TAX Where It Comes From:

Other $21.0 0.3%

Sales/Use $2,396.0 36.4%

Income Taxes $3,682.8 56.0%

Misc/Alcohol/ Tobacco

$373.6 5.7% Insurance Taxes $107.4 1.6%

$6,580.8 MILLION GENERAL REVENUE TAX Where It Is Spent:

Central Services

Refunds to 8210 Taxpayers $533.4 ne 8.1%

Health & Human Services $1,524 23.2%

General Government

$249.6 3.8% Criminal Justice/Military Public Education we $3,517.4 5% 53.4%

Aid to Cities and Counties $50.7 0.8%

Page 20

TAXPAYER BILL OF RIGHTS

Your Rights As A Taxpayer

You have the right to a full explanation of all actions by any employee of the Director of the Department of Finance and Administration both during an audit and during collection activities.

+ All tax information contained in the records and files of the Director of the Department of Finance and Administration (hereinafter “Director”) per- taining to you or your business is confidential subject to exceptions in Ark. Code Ann. § 26-18-303.

+ You may represent yourself in any proceeding or interview before the Director or you may be represented by anyone whom you authorize in writ- ing to be your representative.

+ You have the right to consult with a lawyer, accountant, or other representative at any time during an interview with an employee of the Director. The Director shall suspend the interview to allow you to consult with your representative.

* You may record any interview with the Director or his or her employee at your own expense. You should let the Director or his or her employee know in advance of your intention to record the interview. The Director may likewise record an interview, and a copy may be obtained within a reasonable time at your expense.

* You may request an administrative review (file a protest) of any proposed assessment of tax. You must request this review in writing within 60 days of your receipt of a Notice of Proposed Assessment. The administrative review may be based on an in-person hearing, a telephone hear- ing, or consideration of written documents. If you do not request an administrative hearing, you may still pursue your judicial remedies by filing an action in the circuit court.

+ If you receive an unfavorable decision from your administrative review, then you may request a review of the decision by the Director. This request must be in writing and must be received by the Director within 20 days of the mailing of the hearing decision. If you receive an unfavorable deci- sion from the Director on any issue, you may pursue judicial remedies as discussed below.

+ After the issuance of the Notice of Final Assessment or the final determination of the hearing officer or Director, you may appeal the tax assess- ment to circuit court, regardless of whether you protested the assessment and requested an administrative review. To pursue your appeal of a tax assessment to circuit court you must do one of the following:

(1) File suit within 180 days of the date of the Notice of Final Assessment or final determination of the hearing officer or Director if the taxpayer does not make any payment of the tax, penalty, or interest due; or

(2) Pay the entire amount of tax due within one year of the date of the Notice of Final Assessment or final determination of the hearing officer or Director and file suit within one year of the date of payment; or

(3) File suit within one year of the date of the final determination of the hearing officer or Director to recover assessed tax, penalty, and interest paid prior to the time for issuance of the Notice of Final Assessment.

+ A taxpayer may file an amended return or a verified claim for credit or refund of an overpayment of any state tax within three years from the date the return was filed or two years from the date the tax was paid, whichever is later. Any amended return or claim for refund should be filed with the office of the Revenue Division which administers the type of tax in question. The ability to file an amended return is not available to a taxpayer whose liability was determined as a result of an audit by the Department.

+ If the Director disallows the refund claim either in whole or in part, the Director will issue a Notice of Claim Denial. You may request an administra- tive review (protest) of the Notice of Claim Denial. This request must be made within 60 days of your receipt of the Notice of Claim Denial. If you receive an unfavorable decision from your administrative review, you may request a review of the decision by the Director. This request must be made in writing within 20 days of the mailing of the hearing decision.

+ Following an administrative hearing and corresponding review, the taxpayer may seek judicial relief from the Notice of Claim Denial by appealing the decision to circuit court. Judicial review is available whether or not you requested an administrative review. To pursue your appeal to circuit court, you must file suit within one year of the date of the mailing of the Notice of Claim Denial, the final determination of the hearing officer, or revision decision of the Director, whichever is later. If the Director fails to issue a written decision in response to the refund claim within six months of the date a claim for refund is filed, the taxpayer may then file suit to recover the amount claimed.

+ Any taxpayer who wishes to file a request for administrative review (protest) of a proposed assessment or a complaint regarding any activity con- cerning the administration or collection of any state tax by the Revenue Division should make the protest or complaint in writing to:

ASSISTANT COMMISSIONER FOR POLICY AND LEGAL Mailing Address: LEDBETTER BUILDING, ROOM 2440, P.O. BOX 1272, LITTLE ROCK, AR 72203-1272 Overnight Mailing Address: LEDBETTER BUILDING, ROOM 2440, 1816 W. 7TH ST., LITTLE ROCK, AR 72201

Email Address: protest@dfa.arkansas.gov Fax: (501) 683-1161

+ In administering the state tax laws, the Director is authorized by law to make an examination or investigation of the business, books, and records of the taxpayer. If the Director determines that an additional amount of tax is due, then a Notice of Proposed Assessment shall be issued to the taxpayer. The taxpayer may seek relief from the Notice of Proposed Assessment as outlined above. If the taxpayer fails to preserve and maintain records suitable to determine the amount of tax due or to prove accuracy of any return, the Director may make an estimated assessment based upon the best information available as to the amount of tax due by the taxpayer.

* The Director may issue a jeopardy assessment against any taxpayer (1) whose tax liability exceeds any bond on file indemnifying the state for the payment of a state tax, (2) who intends to leave the state, remove his or her property, or conceal himself or herself or his or her property, (3) who intends to discontinue his or her business without making adequate provisions for payment of state taxes, or (4) who does any other act tending to prejudice or jeopardize the Director’s ability to compute, assess, or collect any state tax. Any taxpayer seeking relief from a jeopardy assessment must request an administrative hearing within five days from the receipt of the Notice of Proposed Assessment.

+ When collecting any state tax due from a taxpayer, the Director is authorized to file a Certificate of Indebtedness (state tax lien) with the circuit clerk of any county of this state certifying that the person named therein is indebted to the state for the amount of tax due as established by the Director. The Certificate of Indebtedness shall have the same force and effect as the entry of a judgment rendered by a circuit court and shall constitute a lien upon the title of any real and personal property of the taxpayer in the county where the Certificate of Indebtedness is recorded.

+ After the filing of the Certificate of Indebtedness, the Director may take all steps authorized by law for the collection of the tax, including the issu- ance of a writ of execution, garnishment, and cancellation of any state tax permits or registrations.

Any court costs or sheriff's fees which result from the Director’s attempt to collect delinquent taxes shall be collected from the taxpayer in addition to the tax, interest, and penalties included in the Certificate of Indebtedness. Revised 02/2016

Page 21

2016 Low Income Tax Tables QUALIFICATIONS:

1. Your total income from all sources (regardless of whether the income is taxable to Arkansas) must fall within the limits of the

2. Married couples must file a joint return (Filing Status 2) to qualify to use these tables. 3. If you use an exemption for military compensation or employment related pension income, you do not qualify. 4. If you itemize your deductions, you must use the Regular Tax Table. 5. Find your Adjusted Gross Income from Line 24, AR1000F/AR1000NR, in the appropriate table below. Your tax is to the right of this amount. Enter the tax on Line 27, AR1000F/AR1000NR. Head of Head of . Household/Qualifying Household/Qualifying Single Widow(er) with 1 or No Widow(er) with 2 or More (FILING STATUS 1) Dependents Dependents (FILING STATUS 3 or 6) (FILING STATUS 3 or 6) IF YOUR ADJUSTED IF YOUR ADJUSTED IF YOUR ADJUSTED GROSS INCOME IS GROSS INCOME IS GROSS INCOME IS YOUR YOUR YOUR FROM To TAX IS FROM To TAX IS FROM To TAX IS 0 11,736 0 0 16,686 0 0 19,891 0 11,737 11,800 35 16,687 16,700 72 19,892 19,900 100 11,801 11,900 43 16,701 16,800 83 19,901 20,000 114 11,901 12,000 50 16,801 16,900 93 20,001 20,100 127 42,001 12,100 57 16,901 17,000 104 20,101 20,200 140

: ; 17,001 17,100 M4 20,201 20,300 154 12,101 12,200 65 , :

, ; 17,101 17,200 124 20,301 20,400 167 12,201 12,300 72 17,201 17,300 135 , 20500 481 12,301 12,400 80 17,301 17,400 145 20,401 ; tod 12,401 12,500 87 17,401 17,500 156 20,501 20,600 42.501 42.600 9A 17.501 17,600 166 20,601 20,700 207

; ; 17,601 17,700 176 20,701 20,800 221 12,601 12,700 102 , ,

42-701 42800 409 17,701 17,800 187 20,801 20,900 234

, , 17,801 17,900 197 20,901 21,000 248 12,801 12,900 17 17,901 18,000 208 21,001 21,100 261 12,901 13,000 124 18.001 18.100 218 21.101 21.200 274 13,001 13,100 131 18,101 18,200 228 21201 21.300 288 13,101 13,200 139 18,201 18,300 239 21.301 21,400 301 13,201 13,300 146 18,301 18,400 249 24,401 21,500 315 13,301 13,400 154 teeot eae cals 21,501 21,600 328 13,401 13,500 161 , ” 21,601 21,700 341 13,501 13,600 168 18,601 18.700 280 355

18,701 | 18,800 291 21,701 | 21,800 13,601 13,700 176 18,801 18,900 301 21,801 21,900 368 13,701 13,800 183 18,901 19,000 312 21,901 22,000 382 13,801 13,900 191 19,001 19,100 322 22,001 22,100 395 13,901 14,000 198 19,101 19,200 332 22,101 22,200 408 14,001 14,100 205 19,201 19,300 343 22,201 22,300 422 44,101 14,200 213 19,301 19,400 353 22,301 22,400 435

19,401 19,500 364 22,401 22,500 449 14,201 14,300 220 5 , 19,501 19,600 374 22,501 22,600 462 14,301 14,400 228 , , 19,601 19,700 384 22,601 22,700 475 14,401 14,500 235 19.701 19,800 305 39 800 4130 14,501 14,600 242 19.801 19,900 405 oe eot oo e00 nop 14,601 14,700 250 19,901 20,000 416 , 33000 B16 14,701 14,800 257 20,001 20,100 426 22,901 ,

; 20,101 20,200 436 23,001 23,100 529 14,801 14,900 265 : ,

14,901 | 15,000 273 20,201 | 20,300 447 23,101 28,200 mae

, , 20,301 20,400 457 23,201 23,300 556 15,001 15,100 281 20,401 20,500 468 23,301 23,400 569 15,104 15,200 289 20,501 20,600 478 23,401 23,500 603

*Above $15,200 use Standard or Itemized 20,601 20,700 488 23,501 23,600 617 Deductions and Regular Tax Table 20,701 20,800 499 23,601 23,700 631 (Rev 10/24/16) 20,801 20,900 509 23,701 23,800 645 20,901 aro 520 23,801 23,900 659 21,001 , 530 23,901 24,000 673 21,101 21,200 540

21201 21300 551 24,001 24,100 687 21301 21400 561 24,101 24,200 701 24,201 24,300 715

*Above $21,400, use Standard or Itemized

Deductions and Regular Tax Table *Above $24,300, use Standard or Itemized

Deductions and Regular Tax Table

appropriate table based on your filing status.

Page 22

2016 Low Income Tax Tables

QUALIFICATIONS:

Your total income from all sources (regardless of whether the income is taxable to Arkansas) must fall within the limits of the

1.

ARON

appropriate table based on your filing status.

Married couples must file a joint return (Filing Status 2) to qualify to use these tables. If you use an exemption for military compensation or employment related pension income, you do not qualify.

If you itemize your deductions, you must use the Regular Tax Table.

Find your Adjusted Gross Income from Line 24, AR1000F/AR1000NR, in the appropriate table below. Your tax is to the right of this amount.

Enter the tax on Line 27, AR1000F/AR1000NR.

Married Filing Joint

With One or No Dependents (FILING STATUS 2)

IF YOUR ADJUSTED GROSS INCOME IS YOUR TAX IS

FROM To

0 19,793 0 19,794 19,800 80 19,801 19,900 91 19,901 20,000 103 20,001 20,100 114 20,101 20,200 126 20,201 20,300 137 20,301 20,400 148 20,401 20,500 160 20,501 20,600 171 20,601 20,700 183 20,701 20,800 194 20,801 20,900 205 20,901 21,000 217 21,001 21,100 228 21,104 21,200 240 21,201 21,300 251 21,301 21,400 262 21,401 21,500 274 21,501 21,600 285 21,601 21,700 297 21,701 21,800 308 21,801 21,900 319 21,901 22,000 331 22,001 22,100 342 22,101 22,200 354 22,201 22,300 365 22,301 22,400 376 22,401 22,500 388 22,501 22,600 399 22,601 22,700 ait 22,701 22,800 422 22,801 22,900 433 22,901 23,000 445 23,001 23,100 456 23,101 23,200 468 23,201 23,300 479 23,301 23,400 490 23,401 23,500 502 23,501 23,600 513 23,601 23,700 525 23,701 23,800 536 23,801 23,900 547 23,901 24,000 559 24,001 24,100 570 24,101 24,200 582 24,201 24,300 593

*Above $24,300, use Standard or Itemized Deductions and Regular Tax Table

(Rev 10/24/16)

Married Filing Joint With Two or More Dependents (FILING STATUS 2) IF YOUR ADJUSTED GROSS INCOME IS FROM TO YOUR TAX IS 0 23,821 0 23,822 23,900 116 23,901 24,000 128 24,001 24,100 139 24,101 24,200 151 24,201 24,300 162 24,301 24,400 173 24,401 24,500 185 24,501 24,600 196 24,601 24,700 208 24,701 24,800 219 24,801 24,900 230 24,901 25,000 242 25,001 25,100 253 25,101 25,200 265 25,201 25,300 276 25,301 25,400 287 25,401 25,500 299 25,501 25,600 310 25,601 25,700 342 25,701 25,800 354 25,801 25,900 366 25,901 26,000 378 26,001 26,100 390 26,101 26,200 402 26,201 26,300 414 26,301 26,400 426 26,401 26,500 438 26,501 26,600 450 26,601 26,700 462 26,701 26,800 474 26,801 26,900 486 26,901 27,000 498 27,001 27,100 510 27,101 27,200 522 27,201 27,300 534 27,301 27,400 546 27,401 27,500 558 27,501 27,600 570 27,601 27,700 582 27,701 27,800 594 27,801 27,900 606 27,901 28,000 618 28,001 28,100 630 28,101 28,200 642 28,201 28,300 654 28,301 28,400 666 28,401 28,500 678 28,501 28,600 690 28,601 28,700 702 28,701 28,800 714 28,801 28,900 726 28,901 29,000 738 29,001 29,100 750 29,101 29,200 762 29,201 29,300 774 29,301 29,400 786 29,401 29,500 798 29,501 29,600 810 29,601 29,700 822 29,701 29,800 834 29,801 29,900 846 29,901 30,000 858 30,001 30,100 870 30,101 30,200 882 30,201 30,300 894 30,301 30,400 906 30,401 30,500 918 *Above $30,500 use Standard or Itemized Deductions and Regular Tax Table

Page 23

Instructions:

2016 Regular Tax Table

1. Find your net taxable income from Line 26, AR1000F/AR1000NR, in the table below. Your tax is to the right of this amount. 2. Married couples must use the same filing status and tax table. If one spouse uses the Regular Tax Table, then both must use the Regular Tax Table. 3. Be sure to subtract your standard deduction or your itemized deductions from Line 24 before using the regular tax table. If you and your spouse use

Filing Status 4 or 5, make sure you prorate your itemized deductions between you and your spouse.

Current year indexed tax brackets are available on our website at www.dfa.arkansas.gov/offices/incometax/individual

If Your Income If Your Income If Your Income is is is YOUR YOUR YOUR As Much But Less TAX As Much But Less TAX As Much But Less TAX As Than Is As Than Is As Than Is 5,000 0 100 0 5,000 5,100 57 10,000 10,100 192 100 200 1 5,100 5,200 59 10,100 10,200 196 200 300 2 5,200 5,300 62 10,200 10,300 199 300 400 3 5,300 5,400 64 10,300 10,400 202 400 500 4 5,400 5,500 66 10,400 10,500 206 500 600 5 5,500 5,600 69 10,500 10,600 209 600 700 6 5,600 5,700 71 10,600 10,700 213 700 800 7 5,700 5,800 74 10,700 10,800 216 800 900 8 5,800 5,900 76 10,800 10,900 219 900 1,000 9 5,900 6,000 78 10,900 11,000 223 1,000 6,000 1,000 1,100 9 6,000 6,100 81 11,000 11,100 226 1,100 1,200 10 6,100 6,200 83 11,100 11,200 230 1,200 1,300 11 6,200 6,300 86 11,200 11,300 233 1,300 1,400 12 6,300 6,400 88 11,300 11,400 236 1,400 1,500 13 6,400 6,500 90 11,400 11,500 240 1,500 1,600 14 6,500 6,600 93 11,500 11,600 243 1,600 1,700 15 6,600 6,700 95 11,600 11,700 247 1,700 1,800 16 6,700 6,800 98 11,700 11,800 250 1,800 1,900 17 6,800 6,900 100 11,800 11,900 253 1,900 2,000 18 6,900 7,000 102 11,900 12,000 257 2,000 7,000 2,000 2,100 18 7,000 7,100 105 12,000 12,100 260 2,100 2,200 19 7,100 7,200 107 12,100 12,200 264 2,200 2,300 20 7,200 7,300 110 12,200 12,300 267 2,300 2,400 21 7,300 7,400 112 12,300 12,400 270 2,400 2,500 22 7,400 7,500 114 12,400 12,500 274 2,500 2,600 23 7,500 7,600 117 12,500 12,600 277 2,600 2,700 24 7,600 7,700 119 12,600 12,700 281 2,700 2,800 25 7,700 7,800 122 12,700 12,800 285 2,800 2,900 26 7,800 7,900 124 12,800 12,900 289 2,900 3,000 27 7,900 8,000 126 12,900 13,000 293 3,000 8,000 3,000 3,100 27 8,000 8,100 129 13,000 13,100 298 3,100 3,200 28 8,100 8,200 131 13,100 13,200 302 3,200 3,300 29 8,200 8,300 134 13,200 13,300 307 3,300 3,400 30 8,300 8,400 136 13,300 13,400 311 3,400 3,500 31 8,400 8,500 138 13,400 13,500 315 3,500 3,600 32 8,500 8,600 141 13,500 13,600 320 3,600 3,700 33 8,600 8,700 145 13,600 13,700 324 3,700 3,800 34 8,700 8,800 148 13,700 13,800 329 3,800 3,900 35 8,800 8,900 151 13,800 13,900 333 3,900 4,000 36 8,900 9,000 155 13,900 14,000 337 4,000 9,000 4,000 4,100 36 9,000 9,100 158 14,000 14,100 342 4,100 4,200 37 9,100 9,200 162 14,100 14,200 346 4,200 4,300 38 9,200 9,300 165 14,200 14,300 351 4,300 4,400 40 9,300 9,400 168 14,300 14,400 355 4,400 4,500 42 9,400 9,500 172 14,400 14,500 359 4,500 4,600 45 9,500 9,600 175 14,500 14,600 364 4,600 4,700 47 9,600 9,700 179 14,600 14,700 368 4,700 4,800 50 9,700 9,800 182 14,700 14,800 373 4,800 4,900 52 9,800 9,900 185 14,800 14,900 377 4,900 5,000 54 9,900 10,000 189 14,900 15,000 381 (Rev 10/24/2016)

Page 24

2016 Regular Tax Table

If Your Income If Your Income If Your Income is YOUR YOUR YOUR As Much But Less TAX As Much But Less TAX As Much But Less TAX As Than Is As Than Is As Than Is 15,000 27,000 15,000 15,100 386 21,000 21,100 650 27,000 27,100 969 15,100 15,200 390 21,100 21,200 654 27,100 27,200 974 15,200 15,300 395 21,200 21,300 679 27,200 27,300 979 15,300 15,400 399 21,300 21,400 684 27,300 27,400 984 15,400 15,500 403 21,400 21,500 689 27,400 27,500 989 15,500 15,600 408 21,500 21,600 694 27,500 27,600 994 15,600 15,700 412 21,600 21,700 699 27,600 27,700 999 15,700 15,800 A417 21,700 21,800 704 27,700 27,800 1,004 15,800 15,900 421 21,800 21,900 709 27,800 27,900 1,009 15,900 16,000 425 21,900 22,000 714 27,900 28,000 1,014 16,000 28,000 16,000 16,100 430 22,000 22,100 719 28,000 28,100 1,019 16,100 16,200 434 22,100 22,200 724 28,100 28,200 1,024 16,200 16,300 439 22,200 22,300 729 28,200 28,300 1,029 16,300 16,400 443 22,300 22,400 734 28,300 28,400 1,034 16,400 16,500 447 22,400 22,500 739 28,400 28,500 1,039 16,500 16,600 452 22,500 22,600 744 28,500 28,600 1,044 16,600 16,700 456 22,600 22,700 749 28,600 28,700 1,049 16,700 16,800 461 22,700 22,800 754 28,700 28,800 1,054 16,800 16,900 465 22,800 22,900 759 28,800 28,900 1,059 16,900 17,000 469 22,900 23,000 764 28,900 29,000 1,064 17,000 29,000 17,000 17,100 474 23,000 23,100 769 29,000 29,100 1,069 17,100 17,200 478 23,100 23,200 774 29,100 29,200 1,074 17,200 17,300 483 23,200 23,300 779 29,200 29,300 1,079 17,300 17,400 487 23,300 23,400 784 29,300 29,400 1,084 17,400 17,500 491 23,400 23,500 789 29,400 29,500 1,089 17,500 17,600 496 23,500 23,600 794 29,500 29,600 1,094 17,600 17,700 500 23,600 23,700 799 29,600 29,700 1,099 17,700 17,800 505 23,700 23,800 804 29,700 29,800 1,104 17,800 17,900 509 23,800 23,900 809 29,800 29,900 1,109 17,900 18,000 513 23,900 24,000 814 29,900 30,000 1,114 18,000 30,000 18,000 18,100 518 24,000 24,100 819 30,000 30,100 1,119 18,100 18,200 522 24,100 24,200 824 30,100 30,200 1,124 18,200 18,300 527 24,200 24,300 829 30,200 30,300 1,129 18,300 18,400 531 24,300 24,400 834 30,300 30,400 1,134 18,400 18,500 535 24,400 24,500 839 30,400 30,500 1,139 18,500 18,600 540 24,500 24,600 844 30,500 30,600 1,144 18,600 18,700 544 24,600 24,700 849 30,600 30,700 1,149 18,700 18,800 549 24,700 24,800 854 30,700 30,800 1,154 18,800 18,900 553 24,800 24,900 859 30,800 30,900 1,159 18,900 19,000 557 24,900 25,000 864 30,900 31,000 1,164 19,000 31,000 19,000 19,100 562 25,000 25,100 869 31,000 31,100 1,169 19,100 19,200 566 25,100 25,200 874 31,100 31,200 1,174 19,200 19,300 571 25,200 25,300 879 31,200 31,300 1,179 19,300 19,400 575 25,300 25,400 884 31,300 31,400 1,184 19,400 19,500 579 25,400 25,500 889 31,400 31,500 1,189 19,500 19,600 584 25,500 25,600 894 31,500 31,600 1,194 19,600 19,700 588 25,600 25,700 899 31,600 31,700 1,199 19,700 19,800 593 25,700 25,800 904 31,700 31,800 1,204 19,800 19,900 597 25,800 25,900 909 31,800 31,900 1,209 19,900 20,000 601 25,900 26,000 914 31,900 32,000 1,214 20,000 32,000 20,000 20,100 606 26,000 26,100 919 32,000 32,100 1,219 20,100 20,200 610 26,100 26,200 924 32,100 32,200 1,224 20,200 20,300 615 26,200 26,300 929 32,200 32,300 1,229 20,300 20,400 619 26,300 26,400 934 32,300 32,400 1,234 20,400 20,500 623 26,400 26,500 939 32,400 32,500 1,239 20,500 20,600 628 26,500 26,600 944 32,500 32,600 1,244 20,600 20,700 632 26,600 26,700 949 32,600 32,700 1,249 20,700 20,800 637 26,700 26,800 954 32,700 32,800 1,254 20,800 20,900 641 26,800 26,900 959 32,800 32,900 1,259 20,900 21,000 645 26,900 27,000 964 32,900 33,000 1,264 (Rev 10/24/2016)

Page 25

2016 Regular Tax Table

If Your Income If Your Income If Your Income is is is YOUR YOUR YOUR As Much But Less TAX As Much But Less TAX As Much But Less TAX As Than Is As Than Is As Than Is

33,000 39,000 45,000 33,000 33,100 1,269 39,000 39,100 1,608 45,000 45,100 1,968 33,100 33,200 1,274 39,100 39,200 1,614 45,100 45,200 1,974 33,200 33,300 1,279 39,200 39,300 1,620 45,200 45,300 1,980 33,300 33,400 1,284 39,300 39,400 1,626 45,300 45,400 1,986 33,400 33,500 1,289 39,400 39,500 1,632 45,400 45,500 1,992 33,500 33,600 1,294 39,500 39,600 1,638 45,500 45,600 1,998 33,600 33,700 1,299 39,600 39,700 1,644 45,600 45,700 2,004 33,700 33,800 1,304 39,700 39,800 1,650 45,700 45,800 2,010 33,800 33,900 1,309 39,800 39,900 1,656 45,800 45,900 2,016 33,900 34,000 1,314 39,900 40,000 1,662 45,900 46,000 2,022

34,000 40,000 46,000 34,000 34,100 1,319 40,000 40,100 1,668 46,000 46,100 2,028 34,100 34,200 1,324 40,100 40,200 1,674 46,100 46,200 2,034 34,200 34,300 1,329 40,200 40,300 1,680 46,200 46,300 2,040 34,300 34,400 1,334 40,300 40,400 1,686 46,300 46,400 2,046 34,400 34,500 1,339 40,400 40,500 1,692 46,400 46,500 2,052 34,500 34,600 1,344 40,500 40,600 1,698 46,500 46,600 2,058 34,600 34,700 1,349 40,600 40,700 1,704 46,600 46,700 2,064 34,700 34,800 1,354 40,700 40,800 1,710 46,700 46,800 2,070 34,800 34,900 1,359 40,800 40,900 1,716 46,800 46,900 2,076 34,900 35,000 1,364 40,900 41,000 1,722 46,900 47,000 2,082

35,000 41,000 47,000 35,000 35,100 1,369 41,000 41,100 1,728 47,000 47,100 2,088 35,100 35,200 1,374 41,100 41,200 1,734 47,100 47,200 2,094 35,200 35,300 1,380 41,200 41,300 1,740 47,200 47,300 2,100 35,300 35,400 1,386 41,300 41,400 1,746 47,300 47,400 2,106 35,400 35,500 1,392 41,400 41,500 1,752 47,400 47,500 2,112 35,500 35,600 1,398 41,500 41,600 1,758 47,500 47,600 2,118 35,600 35,700 1,404 41,600 41,700 1,764 47,600 47,700 2,124 35,700 35,800 1,410 41,700 41,800 1,770 47,700 47,800 2,130 35,800 35,900 1,416 41,800 41,900 1,776 47,800 47,900 2,136 35,900 36,000 1,422 41,900 42,000 1,782 47,900 48,000 2,142

36,000 42,000 48,000 36,000 36,100 1,428 42,000 42,100 1,788 48,000 48,100 2,148 36,100 36,200 1,434 42,100 42,200 1,794 48,100 48,200 2,154 36,200 36,300 1,440 42,200 42,300 1,800 48,200 48,300 2,160 36,300 36,400 1,446 42,300 42,400 1,806 48,300 48,400 2,166 36,400 36,500 1,452 42,400 42,500 1,812 48,400 48,500 2,172 36,500 36,600 1,458 42,500 42,600 1,818 48,500 48,600 2,178 36,600 36,700 1,464 42,600 42,700 1,824 48,600 48,700 2,184 36,700 36,800 1,470 42,700 42,800 1,830 48,700 48,800 2,190 36,800 36,900 1,476 42,800 42,900 1,836 48,800 48,900 2,196 36,900 37,000 1,482 42,900 43,000 1,842 48,900 49,000 2,202

37,000 43,000 49,000 37,000 37,100 1,488 43,000 43,100 1,848 49,000 49,100 2,208 37,100 37,200 1,494 43,100 43,200 1,854 49,100 49,200 2,214 37,200 37,300 1,500 43,200 43,300 1,860 49,200 49,300 2,220 37,300 37,400 1,506 43,300 43,400 1,866 49,300 49,400 2,226 37,400 37,500 1,512 43,400 43,500 1,872 49,400 49,500 2,232 37,500 37,600 1,518 43,500 43,600 1,878 49,500 49,600 2,238 37,600 37,700 1,524 43,600 43,700 1,884 49,600 49,700 2,244 37,700 37,800 1,530 43,700 43,800 1,890 49,700 49,800 2,250 37,800 37,900 1,536 43,800 43,900 1,896 49,800 49,900 2,256 37,900 38,000 1,542 43,900 44,000 1,902 49,900 50,000 2,262

38,000 44,000 50,000 38,000 38,100 1,548 44,000 44,100 1,908 50,000 50,100 2,268 38,100 38,200 1,554 44,100 44,200 1,914 50,100 50,200 2,274 38,200 38,300 1,560 44,200 44,300 1,920 50,200 50,300 2,280 38,300 38,400 1,566 44,300 44,400 1,926 50,300 50,400 2,286 38,400 38,500 1,572 44,400 44,500 1,932 50,400 50,500 2,292 38,500 38,600 1,578 44,500 44,600 1,938 50,500 50,600 2,298 38,600 38,700 1,584 44,600 44,700 1,944 50,600 50,700 2,304 38,700 38,800 1,590 44,700 44,800 1,950 50,700 50,800 2,310 38,800 38,900 1,596 44,800 44,900 1,956 50,800 50,900 2,316 38,900 39,000 1,602 44,900 45,000 1,962 50,900 51,000 2,322

(Rev 10/24/2016)

Page 26

2016 Regular Tax Table

If Your Income If Your Income If Your Income is is is YOUR YOUR YOUR As Much But Less TAX As Much But Less TAX As Much But Less TAX As Than Is As Than Is As Than Is

51,000 63,000 51,000 51,100 2,328 57,000 57,100 2,688 63,000 63,100 3,048 51,100 51,200 2,334 57,100 57,200 2,694 63,100 63,200 3,054 51,200 51,300 2,340 57,200 57,300 2,700 63,200 63,300 3,060 51,300 51,400 2,346 57,300 57,400 2,706 63,300 63,400 3,066 51,400 51,500 2,352 57,400 57,500 2,712 63,400 63,500 3,072 51,500 51,600 2,358 57,500 57,600 2,718 63,500 63,600 3,078 51,600 51,700 2,364 57,600 57,700 2,724 63,600 63,700 3,084 51,700 51,800 2,370 57,700 57,800 2,730 63,700 63,800 3,090 51,800 51,900 2,376 57,800 57,900 2,736 63,800 63,900 3,096 51,900 52,000 2,382 57,900 58,000 2,742 63,900 64,000 3,102

52,000 64,000 52,000 52,100 2,388 58,000 58,100 2,748 64,000 64,100 3,108 52,100 52,200 2,394 58,100 58,200 2,754 64,100 64,200 3,114 52,200 52,300 2,400 58,200 58,300 2,760 64,200 64,300 3,120 52,300 52,400 2,406 58,300 58,400 2,766 64,300 64,400 3,126 52,400 52,500 2,412 58,400 58,500 2,772 64,400 64,500 3,132 52,500 52,600 2,418 58,500 58,600 2,778 64,500 64,600 3,138 52,600 52,700 2,424 58,600 58,700 2,784 64,600 64,700 3,144 52,700 52,800 2,430 58,700 58,800 2,790 64,700 64,800 3,150 52,800 52,900 2,436 58,800 58,900 2,796 64,800 64,900 3,156 52,900 53,000 2,442 58,900 59,000 2,802 64,900 65,000 3,162

53,000 65,000 53,000 53,100 2,448 59,000 59,100 2,808 65,000 65,100 3,168 53,100 53,200 2,454 59,100 59,200 2,814 65,100 65,200 3,174 53,200 53,300 2,460 59,200 59,300 2,820 65,200 65,300 3,180 53,300 53,400 2,466 59,300 59,400 2,826 65,300 65,400 3,186 53,400 53,500 2,472 59,400 59,500 2,832 65,400 65,500 3,192 53,500 53,600 2,478 59,500 59,600 2,838 65,500 65,600 3,198 53,600 53,700 2,484 59,600 59,700 2,844 65,600 65,700 3,204 53,700 53,800 2,490 59,700 59,800 2,850 65,700 65,800 3,210 53,800 53,900 2,496 59,800 59,900 2,856 65,800 65,900 3,216 53,900 54,000 2,502 59,900 60,000 2,862 65,900 66,000 3,222

54,000 66,000 54,000 54,100 2,508 60,000 60,100 2,868 66,000 66,100 3,228 54,100 54,200 2,514 60,100 60,200 2,874 66,100 66,200 3,234 54,200 54,300 2,520 60,200 60,300 2,880 66,200 66,300 3,240 54,300 54,400 2,526 60,300 60,400 2,886 66,300 66,400 3,246 54,400 54,500 2,532 60,400 60,500 2,892 66,400 66,500 3,252 54,500 54,600 2,538 60,500 60,600 2,898 66,500 66,600 3,258 54,600 54,700 2,544 60,600 60,700 2,904 66,600 66,700 3,264 54,700 54,800 2,550 60,700 60,800 2,910 66,700 66,800 3,270 54,800 54,900 2,556 60,800 60,900 2,916 66,800 66,900 3,276 54,900 55,000 2,562 60,900 61,000 2,922 66,900 67,000 3,282

55,000 67,000 55,000 55,100 2,568 61,000 61,100 2,928 67,000 67,100 3,288 55,100 55,200 2,574 61,100 61,200 2,934 67,100 67,200 3,294 55,200 55,300 2,580 61,200 61,300 2,940 67,200 67,300 3,300 55,300 55,400 2,586 61,300 61,400 2,946 67,300 67,400 3,306 55,400 55,500 2,592 61,400 61,500 2,952 67,400 67,500 3,312 55,500 55,600 2,598 61,500 61,600 2,958 67,500 67,600 3,318 55,600 55,700 2,604 61,600 61,700 2,964 67,600 67,700 3,324 55,700 55,800 2,610 61,700 61,800 2,970 67,700 67,800 3,330 55,800 55,900 2,616 61,800 61,900 2,976 67,800 67,900 3,336 55,900 56,000 2,622 61,900 62,000 2,982 67,900 68,000 3,342

56,000 62,000 68,000 56,000 56,100 2,628 62,000 62,100 2,988 68,000 68,100 3,348 56,100 56,200 2,634 62,100 62,200 2,994 68,100 68,200 3,354 56,200 56,300 2,640 62,200 62,300 3,000 68,200 68,300 3,360 56,300 56,400 2,646 62,300 62,400 3,006 68,300 68,400 3,366 56,400 56,500 2,652 62,400 62,500 3,012 68,400 68,500 3,372 56,500 56,600 2,658 62,500 62,600 3,018 68,500 68,600 3,378 56,600 56,700 2,664 62,600 62,700 3,024 68,600 68,700 3,384 56,700 56,800 2,670 62,700 62,800 3,030 68,700 68,800 3,390 56,800 56,900 2,676 62,800 62,900 3,036 68,800 68,900 3,396 56,900 57,000 2,682 62,900 63,000 3,042 68,900 69,000 3,402

(Rev 10/24/2016)

Page 27

2016 Regular Tax Table

If Your Income If Your Income If Your Income is is is YOUR YOUR YOUR As Much But Less TAX As Much But Less TAX As Much But Less TAX As Than Is As Than Is As Than Is 69,000 69,000 69,100 3,408 75,001 75,101 3,829 81,001 81,101 4,683 69,100 69,200 3,414 75,101 75,201 3,836 81,101 81,201 4,690 69,200 69,300 3,420 75,201 75,301 3,843 81,201 81,301 4,697 69,300 69,400 3,426 75,301 75,401 3,850 81,301 81,401 4,704 69,400 69,500 3,432 75,401 75,501 3,856 81,401 81,501 4,710 69,500 69,600 3,438 75,501 75,601 3,863 81,501 81,601 4,717 69,600 69,700 3,444 75,601 75,701 3,870 81,601 81,701 4,724 69,700 69,800 3,450 75,701 75,801 3,877 81,701 81,801 4,731 69,800 69,900 3,456 75,801 75,901 3,884 81,801 81,901 4,738 69,900 70,000 3,462 75,901 76,001 3,891 81,901 82,001 4,745 70,000 70,000 70,100 3,468 76,001 76,101 3,998 82,001 82,101 4,752 70,100 70,200 3,474 76,101 76,201 4,005 82,101 82,201 4,759 70,200 70,300 3,480 76,201 76,301 4,012 82,201 82,301 4,766 70,300 70,400 3,486 76,301 76,401 4,019 82,301 82,401 4,773 70,400 70,500 3,492 76,401 76,501 4,025 82,401 82,501 4,779 70,500 70,600 3,498 76,501 76,601 4,032 82,501 82,601 4,786 70,600 70,700 3,504 76,601 76,701 4,039 82,601 82,701 4,793 70,700 70,800 3,510 76,701 76,801 4,046 82,701 82,801 4,800 70,800 70,900 3,516 76,801 76,901 4,053 82,801 82,901 4,807 70,900 71,000 3,522 76,901 77,001 4,060 82,901 83,001 4,814 71,000 71,000 71,100 3,528 77,001 77,101 4,167 83,001 83,101 4,821 71,100 71,200 3,534 77,101 77,201 4,174 83,101 83,201 4,828 71,200 71,300 3,540 77,201 77,301 4,181 83,201 83,301 4,835 71,300 71,400 3,546 77,301 77,401 4,188 83,301 83,401 4,842 71,400 71,500 3,552 77,401 77,501 4,194 83,401 83,501 4,848 71,500 71,600 3,558 77,501 77,601 4,201 83,501 83,601 4,855 71,600 71,700 3,564 77,601 77,701 4,208 83,601 83,701 4,862 71,700 71,800 3,570 77,701 77,801 4,215 83,701 83,801 4,869 71,800 71,900 3,576 77,801 77,901 4,222 83,801 83,901 4,876 71,900 72,000 3,582 77,901 78,001 4,229 83,901 84,001 4,883 72,000 72,000 72,100 3,588 78,001 78,101 4,336 84,001 84,101 4,890 72,100 72,200 3,594 78,101 78,201 4,343 84,101 84,201 4,897 72,200 72,300 3,600 78,201 78,301 4,350 84,201 84,301 4,904 72,300 72,400 3,606 78,301 78,401 4,357 84,301 84,401 4,911 72,400 72,500 3,612 78,401 78,501 4,363 84,401 84,501 4,917 72,500 72,600 3,618 78,501 78,601 4,370 84,501 84,601 4,924 72,600 72,700 3,624 78,601 78,701 4,377 84,601 84,701 4,931 72,700 72,800 3,630 78,701 78,801 4,384 84,701 84,801 4,938 72,800 72,900 3,636 78,801 78,901 4,391 84,801 84,901 4,945 72,900 73,000 3,642 78,901 79,001 4,398 84,901 85,001 4,952 73,000 73,000 73,100 3,648 79,001 79,101 4,505 85,001 85,101 4,959 73,100 73,200 3,654 79,101 79,201 4,512 85,101 85,201 4,966 73,200 73,300 3,660 79,201 79,301 4,519 85,201 85,301 4,973 73,300 73,400 3,666 79,301 79,401 4,526 85,301 85,401 4,980 73,400 73,500 3,672 79,401 79,501 4,532 85,401 85,501 4,986 73,500 73,600 3,678 79,501 79,601 4,539 85,501 85,601 4,993 73,600 73,700 3,684 79,601 79,701 4,546 85,601 85,701 5,000 73,700 73,800 3,690 79,701 79,801 4,553 85,701 85,801 5,007 73,800 73,900 3,696 79,801 79,901 4,560 85,801 85,901 5,014 73,900 74,000 3,702 79,901 80,001 4,567 85,901 86,001 5,021 74,000 74,000 74,100 3,708 80,001 80,101 4,614 74,100 74,200 3,714 80,101 80,201 4,621 . 74,200 74,300 3,720 80,201 80,301 4,628 PLEASE NOTE: 74,300 74,400 3,726 80,301 80,401 4,635 74,400 74,500 3,732 80,401 80,501 4,641 For $86,001 and over, your 74,500 74,600 3,738 80,501 80,601 4,648 . 74,600 74,700 3,744 80,601 80,701 4,655 tax is $5,021 + 6.9% of the 74,700 74,800 3,750 80,701 80,801 4,662 74,800 74,900 3,756 80,801 80,901 4,669 excess over $86,000 74,900 75,001 3,762 80,901 81,001 4,676

(Rev 11/10/2016)

Page 28

ARKANSAS INDIVIDUAL INCOME TAX INDEX TO INSTRUCTIONS

2016

H Adjustments to INCOME...........0:: cee 13 Head of Household... cece eee 10-11 Adoption Expense Credit. . Alimony Paid AR1000ADJ I Alimony Received. Identity Theft

Amended Returns. Amount You Owe or Refund Due

Annuities Arkansas Tax Deferred Tuition Savings Program... AR1000-CO AR1000ADJ B

Baby Sharon’s Children’s Catastrophic

Illness Program AR1000-CO Blindness - Personal Credit Border City Exemption.... Business Income and Expenses . Business Incentive Tax Credits

c

Capital Gains and Losses... Casualty and Theft Losses +16 Check Offs AR1000-CO Child and Dependent Care Expense -

Credit for. Child Support - Exempt Income. Contributions - Charitable... Credits Against Tax............... AR1000TC, 11, 14 Credit for Tax Paid to Another State......... AR1000TC

. AR1000D, 5, 12

D Deafness - Personal Credit DefinitionS..............0000 Depletion Allowance Rates Depreciation Developmentally Disabled Individual -

Credit for. Disability Income

Disabled Individual Adjustment. -AR1000ADJ Disaster Relief Program AR1000-CO Dividends..........ccccccceceeeecseeeeteeeeeseseeeeeaneees 12 E

Early Childhood Credit........0.0000cceeeeeeees 14

Electronic Filing . Estimated Tax.

Extension of Time to File .............cceeeeeseeees 9 F

Farm Income and Expenses............::1ceeee 13 Filing Requirements.

Filing Status....... Forms (How to Obtain)

G

Gambling Gifts - Exempt Income see Gifts to Charity... cece eee eee

Income - Exempt from Tax. Income to be Reported.. Individual Retirement Accounts:

Contributions to ...

Distributions from

Phaseout Chart Interest Expense... Interest INCOMEC..........ccccceceeeseeeeteteeeeeseeeeees Interest - Penalty on Premature

Withdrawal of Savings................ AR1000ADJ Interest Paid on Student Loans ..AR1000ADJ, 18 Itemized Deductions.................. AR3, 13, 16, 17 IRA Distributions and

Fully Taxable Annuities ......0.0...00.. 12,14 K Keogh Plan - Deduction for ............ AR1000ADJ L Life INSUPANCE ....... eee ces te teeeeseeeeteeeteenenes 9

Long-Term Intergenerational Trust. Lump-sum Distributions

M Mailing Information Married Persons - Filing Joint or Separate Returns Medical and Dental Expenses. Medical Savings Accounts. Mileage Allowance Rates .. Military Compensation -

16-17 . AR1000ADJ

Exempt Amount ...........::ccsceeceseeeereeeeee 10-12 Military Personnel - Home of RECOrd ...........cccceseceeeeseeeeeeeee 7, 8,12

Minister’s Income -

Moving Expense.............00000 AR1000ADy, 19 N Net Operating Loss (NOL)... 13 Newborn Umbilical Cord Blood

Initiative oo. eee AR1000-CO oO

Organ Donor Awareness

Education Program... Other Gains and Losses Other INCOME.........sececeeeeeseseeeeteeeseteeeseeeeeeneneee

. AR1000-CO

P Partnerships ..... Pay by Credit Card Payments........0.0cccceeeeseseeeeeeeneeeeeeeee Penalty: Early Withdrawal of Savings Frivolous Return Late Filing.. Late Payment

P (continued)

Pensions and Annuities .... Personal Tax Credits we Proration of Itemized Deductions

10, 12-13

R Railroad Retirement Benefits..................000 10 Refund or Amount You Owe. Rental Income ............... Request Copies of Tax Returns .. Retirement -

First $6,000 Exempt .. Royalties

s Sale of Home Scholarships, Fellowships,

and Grants... School for the Blind,

Contribution to .........ccceceeeeees AR1000-CO School for the Deaf,

Contribution to... . AR1000-CO Self-employed Health Insurance. . AR1000ADJ

Set Off Refunds 65 Special Personal Credit Social Security Benefits... Standard or Itemized Deduction. Stipends.

Student Loan Interest .............. AR1000AD4J, 18

T Tax Proration .... Tax Computation

Taxes You May Deduct

Texarkana - Exemption...............5

Tuition Savings Program seteteesesese-AR1000ADJ, AR1000-CO

U

Underestimate Penalty Unemployment Compensation

Vv Veterans Benefits - Exemp Vouchers.

Ww. Wages, Salaries, Tips.........0.c eee 1 When to File .. Where to File. Who Must File Widow(er), Qualifying . Workers Compensation .

Page 29

397207 PRESORTED State of Arkansas STANDARD State Income Tax US. pape P. O. Box 1000 STATE OF Little Rock, AR 72203-1000 ARKANSAS.

BEFORE YOU MAIL YOUR RETURN CHECKLIST

YOU MUST FILE BY APRIL 15, 2017

[_]_ 1. Is your name and address correct on the preprinted color label? If so, it should be placed on the front of your return. (Use this label even if you take your return to another person for preparation or you use software to prepare it.) If not, did you enter the name(s) and address for you and your spouse in the space pro- vided on the front of your return?

. Did you enter the correct Social Security Number(s) for you and your spouse? (You must enter the SSN(s) on the return whether you use the color peel off label or not.)

O

3. Did you use the correct filing status column and the correct taxable income to find your tax from the tax table?

4. Did you attach all W-2(s)? 5. Did you add and subtract correctly when calculating refund or amount owed? 6. Did you sign and date your return?

7. Did you keep a complete copy of your return for your records? (Keep for 6 years).

OOOoOdd Oo

8. Have you mailed your return by APRIL 15, 2017?

PLEASE ALLOW UP TO 10 WEEKS FOR YOUR RETURN TO PROCESS.