PRINT FORM 2023 AR1000F |

ARKANSAS INDIVIDUAL INCOME TAX RETURN Full Year Resident

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CHECK BOX IF

AMENDED RETURN Software ID

Jan. 1 - Dec. 31, 2023 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

TAXPAYER INFORMATION

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

1 Check if address is outside U.S.

e City State or province ZIP Foreign country name e ° e

Primary email Secondary email

e oO We 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.

e oO Check here if you want a tax booklet mailed to you

e C] 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) (mmi/dd/yyyy) Issue date Expiration date

DL#/ State ID Spouse state (mmidd/yyyy) (mmidd/yyyy)

1.0 [_] Single (Or widowed before 2023 or divorced at end of 2023)

4.e@ CL] Married filing separately on the same return

a 2 Zz | 2.0 | 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 2/30 | Head of household (See instructions) Fd If the qualifying person was your child, but not your dependent, 6.0 | Surviving spouse with dependent child enter child's name here: Year spouse died: (See instructions) 7c] Yourself eC] 65 or over eC] 65 Special oL] Blind e | Deaf | Head of household/surviving spouse | Spouse | 65 or over eL_] 65 Special | Blind e | Deaf Multiply number of boxes checked . ~L_| X $29 = 00) Dependents (Do not list yourself or spouse) e First name Last name Dependent’s social security number Dependent’s relationship to you o |1. aa 2a Fy 8 3. 4 wa. 5.

7B. Multiply number of DEPENDENTS from above.

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

Individuals with Developmental Disabilities Credit (AR1000-DD - formerly AR1000RC5) now on Form AR1000TC

AR1000F, Page 1 (R 7/3/2023)

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Primary SSN

ROUND ALL AMOUNTS TO WHOLE DOLLARS A enema |e) Seated Only. 8. Wages, salaries, tips, etc: (Attach W-2S) o.......cccecceeccseecseceseeeeeeeseeeceeeseeeeeeeseeeseseseeteeaes 8 je O0je@ 00 9. Military pay: Primary Spouse |e 00 10. Interest income: (If over $1,500, attach ARA) o...c.cccccccccccssssssssssessesseesestestesteseesesseeneane 10 |e O0le 00 11. Dividend income: (If over $1,500, attach AR4) ........c.cceceeceecesesceceeseeeeeeeeeeseseeeeeeeeees 11 |e Ole 00 12. Alimony and separate maintenance received: ...........::cecccececeseseceseseseeeeeseeeeeteeseseeeeesees 12 |e 00le 00 13. Business or professional income: (Attach federal Sch. C) .......c.cceccceeceseesseseeeteeseeteeeees 13 |e 00\e 00 14. Capital gains/(losses) from stocks, bonds, etc: (Attach federal Sch. D) ............::0:cce 14 |e O0le 00 15. Other gains or (losses): (See IMstruCctionS) 0.0.2... cece cece eeeeceeeeeeeseeeeeeeeeeeeeeseseeeeeeees 15 |e@ 00le 00 r 16. Non-qualified IRA distributions and taxable annuities: (Attach All 1099Rs) ................ 16 |e 00|e 00 3 17. Military retirement: Primary [e [oo] Spouse |e [oo] = 418A. Primary employer pension plan(s)/qualified IRA(s): (See inst., attach 1099Rs) Gross Taxable [e ————_—=*[00 $6000 18A\ © 00 18B.Spouse employer pension plan(s)/qualified IRA(s): (See inst., attach 1099Rs) Gross Taxable [e ———————«*[(00 $e'000 18B\e Oole 90 19. Rents, royalties, partnerships, estates, trusts, etc.: (Attach federal Sch. E) ................ 19 |e 00le 00 20. Farm income: (Attach federal SCh. F) ......cccccccccsessssssessssesesesceeeseseseescsescaneseseseeeeneneees 20 |e 00\e 00 21. Umemployment .......ccccececcececceecseeseseeeeseeeeseescaeeseseseenecaeeesesecsecseseessecaeneeeeeeeecenseeeeeeeate 21 |e Ole 00 22. Other income/depreciation differences: (Attach Form AR-Ol) ......0..cc eee 22 |e 00|e 00 23. TOTAL INCOME: (Add lines 8 through 22) ...........:cceceeeeeeseseseeteeeeeseeteeaeeeeees 23 |e 00\e 00 24. TOTAL ADJUSTMENTS: (Attach Form AR1000ADV) ..0...... cece ceeteteeeeeeteeees 24 |e 00\e 00 25. ADJUSTED GROSS INCOME: (Subtract line 24 from line 23) .. e ooje@ 00 26. Select tax table: (Select only one) 26 27. e [] Low income table ($0), See line 26 instructions e [_] Standard deduction (See instructions) z ¢ (J Itemized deductions (Attach AR3) 27 |e O0le 00 28. NET TAXABLE INCOME: (Subtract line 27 from line 25) «0.0.0.0... 28 |e 00|e 00 > = | 29. TAX: (Enter tax from tax table) ..............cc cece cece ee eeee ee eeeeneeeeseseeeeneneeseeeneeeeeeeeeneea 29 00 00 é 30. Combined tax: (Add amounts from line 29, columns A and B) ...........0.0cc cee eee eeeeeeeeeteeeteeeeeeneee 30 00 "131. Enter tax from Lump Sum Distribution Averaging Schedule: (Attach AR1000TD) ..........e eects 31 Le 00 32. Additional tax on IRA and qualified plan withdrawal and overpayment: (See instructions) «0.0.0.0... 32 |@ 00 33. TOTAL TAX: (Add lines 30 through 32) 0... ccscecssecssecec es ess ess eseesesecseseeeeesesteseesesecnseseseeesssseseeeeeeeees 33 |¢ 00 34. Personal tax credit(s): (Enter total from lime 7C) .............:.:cccccecscesesseeceeeeeeteeseeeeeeeeees 34 |e 00 e 35. Child care credit: (Attach AR2441) .......ccccccccccscscssessesessesesseseseesssceseseesssestsucstsscsteseseaees 35 |e 00 5 36. Other credits: (Attach AR1000TC) .o....c.ccecccccccscssssesssseesessesesseseseesssescstesesrssesseaeeseeees 36 Le 00 Z 37. TOTAL CREDITS: (Add lines 34 through 36) .. 07 |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 6/13/2023)

Primary SSN

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39. Arkansas income tax withheld: (Attach copies of W-2, 1099R, W2-G,1099-PT, and/or AR-K1) ............5 39 |@ 00 40. Estimated tax paid or credit brought forward from 2022: ......e.ecccccccseseseeseseeeeeseseseseseeeeeecseseseseseseeeteeaeeeeeeeeeee 40 |e 00 41. Payment made with extension: (See instructions) .............cc cece eects eeeeeeeeeseeeeeeeeeeeeeeecsecseeecseesensesenetaeeee 41 |e 00

é 42. AMENDED RETURNS ONLY - Previous payments: (See instructions) ............0...:.::ccceseeseeeeeeeeeeeeeee 42\e 00

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5 43. Early childhood program: Certification number:

a (Attach AR1000EC and AR2441) ooo... cscs eescesseneeesesennteceessnescesssneeessneteseessniesessneneeessnetessssniesesssnteeesnneeesessneeneeete 43 |e 00 44. TOTAL PAYMENTS: (Add lines 39 through 43) .. e 00 45. AMENDED RETURNS ONLY - Previous refund: (See instructions) ...............c:ccccceeeceeeeeeeeeeeeeeeeeeeeeee 45 |e 00 46. Adjusted total payments: (Subtract line 45 from line 44) .o......eecccceccccececeeceeeeseececeeceeeceseeceeeeseeeseteeteeeeneeee 46 |e 00 47. AMOUNT OF OVERPAYMENT/REFUND: (If line 46 is greater than line 38, enter difference) ......... 47 |e 00

w 48. Amount to be applied to 2024 estimated tax: .......eececcccccceeeceeesceeceeeeseeetseeeeeeeeeeeeeeeee 48

a 49. Amount of Check-Off contributions: (Attach Form AR1000CO) ......:sssssessessessee ag[e_ oo

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% 50. AMOUNT TO BE REFUNDED TO YOU: (Subtract lines 48 and 49 from line 47) ........... REFUND 50¢© ——_foo

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5 51. AMOUNT DUE: (if line 46 is less than line 38, enter difference; If over $1,000, continue to 52A) ........... TAX DUE 51 {o_o

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© | 52\. UEP: Attach Form AR2210 or AR2210A. If required, enter exception in box 52A[e | Penalty 52BLe [oo] 52C. Add lines 51 and 52B: (See instructions) ... . TOTAL DUE socle_—_—00 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 C Checking or @ CL Savings Direct deposit 1 amt.

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a Routing number 2 Account number 2 e CT] Checking or @ Cc 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

y information of which preparer has any knowledge.

au |.Primary’s signature Date Telephone May the Arkansas

itz Revenue Division

Oe — discuss this return | Spouse ‘s\signature Date Telephone with the preparer? | Paid preparer's signature PTIN/ID number [J Yes [7] No

e For Depart Use Only Preparer’s name Telephone A e 4

az] Address

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4 *! City State ZIP E-mail

PAY ONLINE: 7 Mail Return & Payment to:

Please visit our secure website ATAP (Arkansas Taxpayer Access Point) at Oa) Refund: Tax Due/No Tax:

www.atap.arkansas.gov. ATAP allows taxpayers or their representatives to ee : "

log on, make payments and manage their account online. ATAP is available Fa "i ANEURES SE INES TENS HUES S216 lea TE

oa hou ; Oe P.O. Box 1000 P.O. Box 2144 jours: Little Rock, AR 72203-1000 Little Rock, AR 72203-2144

AR1000F Page 3 (R 7/5/2023)