PRINT FORM 2021 AR1000F

ARKANSAS INDIVIDUAL INCOME TAX RETURN Full Year Resident

Mn ni ITAR211

AR1

Software ID

CHECK BOX IF AMENDED RETURN

Jan. 1 - Dec. 31, 2021 or fiscal year ending ,20 e e e| DFA WEB Primary’s legal first name MI Last name Check if Primary’s social security number ul? e e © [1 Deceased | @ 5s Spouse's legal first name MI Last name Check if Spouse’s social security number azle ° ° © L1Deceased | © $2 Mailing address (number and street, P.O. box or rural route) Check if address is outside U.S. “City State or province ZIP Foreign country name e ° ° a8 1.0 | Single (Or widowed before 2021 or divorced at end of 2021) 4.e@ C] Married filing separately on the same return a) go 2.0 LL] Married filing joint (Even if only one had income) 5.e L] Married filing separately on different returns 96 3.0 im Head of household (See instructions) Enter spouse's name here and SSN above i If the qualifying person was your child, but not your dependent, 6.e | Surviving spouse with dependent child ze enter child’s name here: Year spouse died: (See instructions) e oO Check here if you want a tax booklet mailed to you next year. e | Check this box if you have filed a state extension or an automatic federal extension 7A] Yourself eC] 65 or over eL_] 65 Special eC] Blind e | Deaf | Head of household/surviving spouse | Spouse Oa 65 or over | 65 Special | Blind e CL] Deaf e Multiply number of boxes checked = 00) a Dependents (Do not list yourself or spouse) & First name Last name Dependent's social security number Dependent’s relationship to you x £1. a Z 2. i) FA 3. ® |7B. Multiply number of DEPENDENTS from above 7B @ | X $29 = 00 7C. Multiply number of qualifying individuals from AR1000RC5 (See instructions) ............000 cece TC @ CL] X $500 = 00) 7D. TOTAL PERSONAL TAX CREDITS: (Add lines 7A, 7B, and 7C. Enter total here and on line 34) ............:.::ceseeseeeeereeee 7D 00 Issue date Expiration date DL#/ State ID Your state (mm/dd/yy) (mmiddiyyyy) a - Issue date Expiration date DL#/ State ID Spouse state (mm/dd/yy) (mm/dd/yy) Direct deposit allowed to U.S. banks only. Check if either deposit(s) will ultimately be placed in a foreign account. ef] 5 Routing Number 1 Account Number 1 e Checking or @ Savings Direct deposit 1 Amt i) a ule e e 00 F 3 A Routing Number 2 Account Number 2 e CI Checking or @ Savings Direct deposit 2 Amt e e ry 00 PLEASE SIGN HERE: Under penalties of perjury, | declare that I have examined this return and accompanying schedules and statements, 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. wile oO We will no longer automatically mail 1099-G forms. Instead, we ask that you get this information from our website we (www.atap.arkansas.gov). Check the box if you still want us to mail you a paper Form 1099-G next year. ae Primary’s signature Date Telephone May the Arkansas Revenue a2 Agency discuss this return Spouse’s signature Date Telephone with the preparer? Cl Yes oO No © Paid preparer’s signature PTIN/ID number For Department Use Only of ° A_| le Ff Preparer’s name City/State/ZIP Telephone = E-mail

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ITAR21 Primary SSN (A) Primary/Joint (B) Spouse’s Income ROUND ALL AMOUNTS TO WHOLE DOLLARS Income Status 4 Only

8. Wages, salaries, tips, etc: (Attach W-2S) .......sceeseceeeseeteteeeseeeeees seseeeeee e [oo e [oo

9. Military pay: Primary |@ [oo] Spouse [oo] 10. Interest income: (If over $1,500, Attach AR4) .......scscsssscsseesseesteeeseees e Ole 00 11. Dividend income: (If over $1,500, Attach AR4) ... e Ole 00 12. Alimony and separate maintenance received: e O0je 00 13. Business or professional income: (Attach federal Schedule C) . e Ole 00 14. Capital gains/(losses) from stocks, bonds, etc: (See instructions, Attach federal Schedule D) e O0je 00 15. Other gains or (losses): (Attach federal Form 4797 and/or AR4684 if applicable) e Ole 00 16. Non-qualified IRA distributions and taxable annuities: (Attach All 1099Rs} e O0je 00

17. Military retirement: Primary [e [oo] Spouse [e 18A. Primary employer pension plan(s)/qualified IRA(s): (See instructions, Attach all 1099Rs)

18B. Spouse employer pension plan(s)/qualified IRA(s): (See instructions, Attach all 1099Rs)

“ 9

INCOME

Attach W-2(s)/1099(s) here / Attach check on top of W-2(s)/1099(s)

19. Rents, royalties, partnerships, estates, trusts, etc.: (Attach federal Schedule E) ... O0je 00 20. Farm income: (Attach federal Schedule F) O0je 00 21. Unemployment: — Primary/Joint [eo

22. Other income/depreciation differences: (Attach Form AR-Ol) ...... O0je 00 23. TOTAL INCOME: (Add lines 8 through 22) ........... O0je 00 24. TOTAL ADJUSTMENTS: (Attach Form AR1000ADJ) Ole 00 25. ADJUSTED GROSS INCOME: (Subtract line 24 from line 23) .. oo|e@ 00

26. Select tax table: (Select only one) 26 27. @ oO Low income table ($0), For low income qualifications see line 26 instructions

z e Oo Standard deduction ($2,200 or $4,400 for filing status 2 only)

5 e Oo Itemized deductions (Attach AR3) 27 |@ O0le 00

5 28. NET TAXABLE INCOME: (Subtract line 27 from line 25) 00\e 00

3 | 29. TAX: (Enter tax from tax table) .. 00 00

x 30. Combined tax: (Add amounts from line 29, columns A and B) ..........-.0.000000 30 00

| 31. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) .31 Le 00 32. Additional tax on IRA and qualified plan withdrawal and overpayment: (Attach federal Form 532! .32 |@ 00 33. TOTAL TAX: (Add lines 30 through 32) 33 | @ 00

w | 34. Personal tax credit(s): (Enter total from line 7D) ...........:0seceeee e 00

£135. Child care credit: (Attach AR2441) ° 00

& 36. Other credits: (Attach AR1000TC) .. e 00

2 37. TOTAL CREDITS: (Add lines 34 through 36) 37 [@ 00 38. NET TAX: (Subtract line 37 from line 33. If line 37 is greater than line 33, enter 0) 38 |@ 00 39. Arkansas income tax withheld: (Attach state copies of W-2 and/or 1099R, W2-G) 39 Le 00 40. Estimated tax paid or credit brought forward from 2020: 40 |e 00

a 41. Payment made with extension: (See instructions) 1 |e 00

5 |42. AMENDED RETURNS ONLY - Previous payments: (Se 2 |e 00

= 43. Early childhood program: Certification number:

& (Attach AR1000EC and AR2441) ... e 00 44. TOTAL PAYMENTS: (Add lines 39 through 43) .... 44 |e 00 45. AMENDED RETURNS ONLY - Previous refund: (See instructions) 45 |e@ 00 46. Adjusted total payments: (Subtract line 45 from line 44) .... 46 |@ 00

u 47. AMOUNT OF OVERPAYMENT/REFUND: ((f line 46 is greater than line 38, enter difference) 47 [@ 00

io 48. Amount to be applied to 2022 estimated tax: . 00

= | 49. Amount of Check-off Contributions: (Attach Schedule AR1000-CO) .. ve e 00

5 50. AMOUNT TO BE REFUNDED TO YOU: (Subtract lines 48 and 49 from line 47) REFUND 50¢| © 00

2 51. AMOUNT DUE: (if line 46 is less than line 38, enter difference; If over $1,000, continue to 52A) -TAX ai ni e| 8 00

z 52A. UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 52A [-_]* Penalty 52B)¢

TOTAL DUE = e 00

52C.Add lines 51 and 52B: (See instructions)

Page AR2 (R 7/15/2021)