(PRINT FOR a ARA684 woe 2018

ITCT

ARKANSAS INDIVIDUAL INCOME TAX CASUALTIES AND THEFTS

Primary’s Legal Name Primary’s Social Security Number

SECTION A - Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income-producing purposes. If reporting a casualty loss from a disaster, see the instructions before completing this section.)

1 Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from the same casualty or theft. You must use a separate Form AR4684 (through line 12) for each casualty or theft event involving personal use property.

Property A

Property B

Property C

Property D

Properties A B c D 00 00 00 00

2 Cost or other basis of each property .

3 Insurance or other reimbursement (whether or not you filed a claim) (see instructions) Note: If line 2 is more than line 3, skip line 4.

4 Gain from casualty or theft. If line 3 is more than line 2, enter the difference here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you

00 00 00 00

received payment for your loss in a later tax year ... 4 00

5 Fair market value before casualty or theft 5 00 6 Fair market value after casualty or theft 6 00 7 Subtract line 6 from line 5 . 7 00 8 Enter the smaller of line 2 or line 7 8 00 9 Subtract line 3 from line 8. If zero or less, enter -O- .........0.0..... 9 00 10 Casualty or theft loss. Add the amounts on line 9 in columns A through D . 00 11 Enter $100 00

12 Subtract line 11 from line 10. If zero or less; Enter -O- .....c.cccccccccsessssssssscscecescssssscscsessecsssssssscsssssssssesesessssssteceeseesessssseteceseseseacese 00 Caution: Use only one Form AR4684 for lines 13 through 18.

13 Add the amounts on line 12 of all Forms AR4684 00 14 Add the amounts on line 4 of all Forms AR4684 00 Caution: See instructions before completing line 15. 15 e Ifline 14 is more than line 13, enter the difference here and adjust on Form AR1000D accordingly. Do not complete the restofthissection, = Et... 15 00 ¢ If line 14 is equal to line 13, enter -O- here. Do not complete the rest of this section. e If line 14 is less than line 13, enter -0- here and go to line 16. 16 Add lines 14 and 15. Subtract the result from line 13 00

17 Enter 10% of your adjusted gross income from Form AR1000F / AR1000NR, line 26. Estates and trusts, see instructions ..... 17 00

18 Subtract line 17 from line 16. If zero or less, enter -0-. Also enter the result on AR3, line 18. Estates and trusts, enter the result on the “Other deductions” line of your tax return

00

Note: If you have business and income-producing property for which casualty or theft gain or loss occured, please attach a statement to report amounts. Enter the amount from Income-producing property on AR3, Line 27. Report Income-producing property used as an employee on AR3, Line 21. Any other gains or losses from business and income-producing property are to be reported on AR1000F/AR1000NR, Line 15. Amounts reported must be in accordance to ACA 26-51-424.

AR4684 (R 12/21/2018)