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AR4 - Interest and Dividend Schedule

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AR4 2008 200841 ARKANSAS INDIVIDUAL INCOME TAX INTEREST AND DIVIDEND INCOME SCHEDULE Social Security Number Name Part I TAXABLE INTEREST INCOME Part II TAXABLE DIVIDEND INCOME Interest on bank deposits, notes, mortgages from individuals, Dividends and other distributions on stock are fully taxable. corporation bonds, savings and loan deposits, and credit union There is no dividend exclusion applicable to Arkansas. deposits are taxable. Interest on obligations of other states and subdivisions are fully taxable. List below the names of the dividend source and designate the ownership by writing Y (Yours), S (Spouse’s) or J (Joint). List below the names of the interest source and designate the ownership by writing Y (Yours), S (Spouse’s) or J (Joint). CLICK HERE TO CLEAR FORM 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 00 Add the amounts listed above and enter the Add the amounts listed above and enter the total here and on Line 11, page AR1/NR1. total here and on Line 12, page AR1/NR1. 00 00 Part III INCOME NOT SUBJECT TO ARKANSAS TAX (See Instructions on pages 11 & 12) 00 00 00 00 00 00 00 00 00 00 00 00 00 00 TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on page AR2/NR2, Line 56) ................................. 00 Page AR4 (R 08/1/08)

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