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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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  • 1. 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)