arkansas individual/fiduciary income tax interest and dividend income schedule · 2017. 11. 7. ·...

00 00 00 00 00 00 00 00 00 00 00 00 00 00 Part III INCOME NOT SUBJECT TO ARKANSAS TAX (See Instructions on pages 11 & 12) 00 TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on Form AR1000F/AR1000NR, Line 51) ............. AR4 ARKANSAS INDIVIDUAL/FIDUCIARY INCOME TAX INTEREST AND DIVIDEND INCOME SCHEDULE Name Social Security Number or FEIN Part II TAXABLE DIVIDEND INCOME Dividends and other distributions on stock are fully taxable. There is no dividend exclusion applicable to Arkansas. List below the names of the dividend sources and designate ownership by writing Y (Yours), S (Spouse’s) or J (Joint). Page AR4 (R 4/22/15) 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. List below the names of the interest sources and designate ownership by writing Y (Yours), S (Spouse’s) or J (Joint). YSJ NAME OF PAYER AMOUNT YSJ NAME OF PAYER AMOUNT 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 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 above and enter the total here and on Line 10, Form AR1000F/AR1000NR or Line 1, Form AR1002F/AR1002NR. 00 2015 Social Security Ministers Housing Allowance Railroad Retirement Beneﬁts Unemployment Add the amounts listed above and enter the total here and on Line 11, Form AR1000F/AR1000NR or Line 2, Form AR1002F/AR1002NR.

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Page 1: ARKANSAS INDIVIDUAL/FIDUCIARY INCOME TAX INTEREST AND DIVIDEND INCOME SCHEDULE · 2017. 11. 7. · AR4. ARKANSAS INDIVIDUAL/FIDUCIARY INCOME TAX. INTEREST AND DIVIDEND INCOME SCHEDULE

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Part III INCOME NOT SUBJECT TO ARKANSAS TAX (See Instructions on pages 11 & 12)

00TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on Form AR1000F/AR1000NR, Line 51) .............

AR4ARKANSAS INDIVIDUAL/FIDUCIARY INCOME TAX

INTEREST AND DIVIDEND INCOME SCHEDULEName Social Security Number or FEIN

Part II TAXABLE DIVIDEND INCOME

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

List below the names of the dividend sources and designate ownership by writing Y (Yours), S (Spouse’s) or J (Joint).

Page AR4 (R 4/22/15)

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.

List below the names of the interest sources and designate ownership by writing Y (Yours), S (Spouse’s) or J (Joint).

YSJ NAME OF PAYER AMOUNT YSJ NAME OF PAYER AMOUNT

0000000000000000000000000000000000000000

00000000

0000000000000000000000000000000000000000

00000000

Add the amounts listed above and enter the total here and on Line 10, Form AR1000F/AR1000NR or Line 1, Form AR1002F/AR1002NR. 00

2015

Social Security

Ministers Housing Allowance

Railroad Retirement BenefitsUnemployment

Add the amounts listed above and enter the total here and on Line 11, Form AR1000F/AR1000NR or Line 2, Form AR1002F/AR1002NR.