00000000000000
00000000000000
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
00
0000000000000000000000000000000000000000
00000000
0000000000000000000000000000000000000000
00000000
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 BenefitsUnemployment
Add the amounts listed above and enter the total here and on Line 11, Form AR1000F/AR1000NR or Line 2, Form AR1002F/AR1002NR.