(PRINT FORM 2022 AR1000F

ARKANSAS INDIVIDUAL INCOME TAX RETURN Full Year Resident

ITAR221

tM P1

CHECK BOX IF AMENDED RETURN

Software ID

Jan. 1 - Dec. 31, 2022 or fiscal year ending , 20 e e e|/ DFA WEB Primary’s legal first name MI Last name Primary’s social security number e e e Check if e e Oo Deceased Spouse’s legal first name MI Last name Spouse’s social security number e e e Check if e e Oo Deceased

Mailing address (number and street, P.O. box or rural route)

0 Check if address is outside U.S.

e z City State or province ZIP Foreign country name Ele e e g FA Primary email Secondary email 4 z e oO We will no longer automatically mail 1099-G forms. Instead, we ask that you get this information from our website & (www.atap.arkansas.gov). Check the box if you still want us to mail you a paper Form 1099-G next year. a 5 e oO Check here if you want a tax booklet mailed to you e Check this box if you have filed a state extension next year. or an automatic federal extension Issue date Expiration date DL#/ State ID Your state (mmidd/yyyy) (mm/dd/yyyy) Issue date Expiration date DL#/ State ID Spouse state (mmidd/yyyy) (mmidd/yyyy) 8 1.0 CL] Single (Or widowed before 2022 or divorced at end of 2022) 4@ L] Married filing separately on the same return z Zz | 2¢ LC] Married filing joint (Even if only one had income) 5.e | Married filing separately on different returns ° Enter spouse’s name here and SSN above z|3.¢ | Head of household (See instructions) FA If the qualifying person was your child, but not your dependent, 6.e | Surviving spouse with dependent child enter child’s name here: Year spouse died: (See instructions)

7aL_] Yourself | 65 or over im Spouse e[_] 65 or over

Multiply number of boxes checked

e_] 65 Special e[_] 65 Special

Dependents (Do not list yourself or spouse)

e[_] Bling e[_] Bling

e | Deaf e C] Deaf

| Head of household/surviving spouse

(Filing status 3 only) (Filing status 6 only)

00)

First name Last name

Dependent’s social security number

Dependent's relationship to you

PERSONAL TAX CREDITS Ny

5.

7B. Multiply number of DEPENDENTS from above..............0.0::ceee

7C. Multiply number of qualifying individuals from AR1000RC5 (See instructions) ................0:0ceeeeeeeeeeeeeeeeee 7C @ | X $500 [oo

7D. TOTAL PERSONAL TAX CREDITS: (Add lines 7A, 7B, and 7C. Enter total here and on line 34) .............::ecceseeseeeeeeeeee 7D [oo

AR1000F, Page 1 (R 7/21/2022)

Ul P2

Primary SSN

ROUND ALL AMOUNTS TO WHOLE DOLLARS “) Prineome ®) *eeatue 4Oaly 8. Wages, salaries, tips, etc: (Attach W-2S) .....c.c.cccccccccccsessesesesesestesescseseseesessstseeeeseaseeees 8 }e 00\e 00 9. Military pay: Primary Spouse |e 00 10. Interest income: (If over $1,500, attach AR4) ... ) 00\e 90 11. Dividend income: (If over $1,500, attach ARA) .......cccccccccecssssseseseseeesestststeeseseseees 11 |e 00\e 00 12. Alimony and separate maintenance reCeiVed: .........ccccccsssescsssesessssssesescsesesesvsceueseseseees 12 |e 00\e 00 13. Business or professional income: (Attach federal SCH. C) ...cc.ccsecscssssesseestesseesseeseessee 13 |e 00\e 00 14. Capital gains/(losses) from stocks, bonds, etc: (Attach federal Sch. D) ..........:cccceee 14 |e 00\e 00 15. Other gains or (losses): (See IMStrUCtiONS) ..........c.cceccccecscessessesesseseesssesesseseeseseseeneaees 15 |e 00\e 00 wy 16. Non-qualified IRA distributions and taxable annuities: (Attach All 1099Rs) ................ 16 |e 00\e 00 8 17. Military retirement: Primary [e [oo] Spouse [e [oo] = 418A. Primary employer pension plan(s)/qualified IRA(s): (See inst., attach 1099Rs) Gross Taxable $6000 18A\@ 90 18B. Spouse employer pension plan(s)/qualified IRA(s): (See inst., attach 1099Rs) Gross Taxable [e ————_—=*[00] $6600 188} O0le 00 19. Rents, royalties, partnerships, estates, trusts, etc.: (Attach federal Sch. E) .............. 19 |e 00|e 00 20. Farm income: (Attach federal SCH. F) ...c.c.ccccccccscssssssesssssescecsnescsesescsesceneneeeesssseseseseees 20 |e 00le 00 21. Unemployment: .......cccccccccsscsessssessesessescsssscsssscsssscssssesssusssasssssssvsucsusscavaucseaucseaueseseseesaee 21 |e 00le 00 22. Other income/depreciation differences: (Attach Form AR-Ol) ......ccccccscesesestseeseees 22 |e@ 00\e 00 23. TOTAL INCOME: (Add lines 8 through 22) .............:.ccccccccceseceseeceseseeeeseeeeeeeeseeeees 23 |@ O0\e 00 24. TOTAL ADJUSTMENTS: (Attach Form AR1000ADvJ) ... 24 |@ 00|e 00 25. ADJUSTED GROSS INCOME: (Subtract line 24 from line 23) .. 25 |@ oo;e@ 00 26. Select tax table: (Select only one) 26 27.¢@ | Low income table ($0), See line 26 instructions e (J Standard deduction (See instructions) z © (1 Itemized deductions (Attach AR3) 27 |@ 00|e 00 E 28. NET TAXABLE INCOME: (Subtract line 27 from line 25) ............cccccccsesesseeees 28 |e 00\e 00 > = | 29. TAX: (Enter tax from tax table) 0.0.0.0... ccc cesses eesesceseseeseseeseseeseeeseeneseesesteneneee 29 00 00 é 30. Combined tax: (Add amounts from line 29, columns A and B) ..............::cccccceseeseeeeeeeeeeeeeeeeeeeaeeeeseeeeeee 30 00 r 31. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) oo. eeeeee 31 |e 00 32. Additional tax on IRA and qualified plan withdrawal and overpayment: (See instructions) ............. ce 32 |e 00 33. TOTAL TAX: (Add lines 30 through 32) .... .33 |@ 00 34. Personal tax credit(s): (Enter total from line 7D) .... 34 Lo 00 e 35. Child care credit: (Attach AR2441) .......cccccccccccscsssesssessseseseuececessenscseecsestsessstseseseeeseee 35 |e 00 5 36. Other credits: (Attach AR1000TC) o...ccccccccccccsccssscssssessssesesesssesssscsssescaueseseseaeecseaee 36 Le 00 Z 37. TOTAL CREDITS: (Add lines 34 through 36) ...............cccccccccecceeeeeeeeeseeeeeeeeeeeeceeeeeaeeeeseesseeeeseteeeeeeeteee 37 |e 00 38. NET TAX: (Subtract line 37 from line 33. If line 37 is greater than line 33, enter 0) .................... 38 |e 00

AR1000F Page 2 (R 7/25/2022)

ITAR223

Mn P3

Primary SSN

39. Arkansas income tax withheld: (Attach copies of W-2, 1099R, W2-G,1099-PT, and/or AR-K1) ............. 39 |@ 00 40. Estimated tax paid or credit brought forward from 2021: .......cececeeeseeseeseeeeeeeseeeeseeeeeeeeeeseceeceeseeceeeesaeeeeeenaees 40 |e 00 41. Payment made with extension: (See instructions) .............c cc ecccec cece eeeceeeeeeeeeeeseceeeeeeaeeeeeeeeesesesaeeeeeeeeees 41\e 00

é 42. AMENDED RETURNS ONLY - Previous payments: (See instructions) .. e 00

4 43. Early childhood program: Certification number:

a (Attach AR1000EC and AR2441) occ eeccssseeecessneesessnneeeesnstesssneseessneessoneesssaueceesanseeesnetesesaueeessneeessntecsssneuiceseneette 43 |e 00 44. TOTAL PAYMENTS: (Add lines 39 through 43) .0.....0...ccccccceseseeseeeceeeceeeeeeseeeeneeseeeeeaeeneeeeeeeeeeeeseneenetee 44 \e 00 45. AMENDED RETURNS ONLY - Previous refund: (See instructions) . e 00 46. Adjusted total payments: (Subtract line 45 from line 44) .......cccececcccccecececeseeesececeeeeceeeeeesesecececeteteeeeeeneetaees 46 |e 00 47. AMOUNT OF OVERPAYMENT/REFUND: (If line 46 is greater than line 38, enter difference) ......... 47 |@ 00

w 48. Amount to be applied to 2023 estimated tax: 20... ccceceeeceeceeeeeeeeeeeeeeeeeeseeeseeeeeeeaeee 48

x 49. Amount of Check-Off contributions: (Attach Form AR1000CO) .. 49

& 50. AMOUNT TO BE REFUNDED TO YOU: (Subtract lines 48 and 49 from line 47) ........... REFUND 50° ——_—{oo|

z 51. AMOUNT DUE: (If line 46 is less than line 38, enter difference; If over $1,000, continue to 52A) ........... TAX DUE 51 (ea _[oo]

® | 524. UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 52A[e Penalty 52B[e 0] 52C. Add lines 51 and 52B: (See instructions) .. TOTAL DUE socle_——_—o| Direct deposit allowed to U.S. banks only. Check if either deposit(s) will ultimately be placed in a foreign account. @ LC]

E Routing number 1 Account number 1 e - Checking or @ C Savings Direct deposit 1 amt.

H e e e 00

§

3 Routing number 2 Account number 2 e LC) Checking or @ L] Savings Direct deposit 2 amt. e e e 00

PLEASE SIGN HERE: Under penalties of perjury, | declare that | 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

Please visit our secure website ATAP (Arkansas Taxpayer Access Point) at www.atap.arkansas.gov. ATAP allows

taxpayers or their representatives to log on, make payments and manage their account online. ATAP is available 24 hours. P.O. Box 1000 P.O. Box 2144

y information of which preparer has any knowledge. we 7 ry " Qui] Primary's signature Date Telephone May the Arkansas a3 Revenue Division *3 Ter discuss this return Spouse's signature Date Telephone with the preparer? Paid preparer’s signature PTIN/ID number [yes [| No e For Department Use Only Preparer’s name Telephone A e 4 at Address a5 oe ™! City State ZIP E-mail PAY ONLINE: Refund: Tax Due/No Tax:

Arkansas State Income Tax Arkansas State Income Tax

PAY BY MAIL: (See instructions) PAY BY CREDIT CARD: (See instructions) Ii IRtereS AR 2ztokemiteele) tite [Rtetes ALR 2 eae

AR1000F Page 3 (R 8/25/2022)