Form AR4 Interest and Dividends Schedule

Part III INCOME NOT SUBJECT TO ARKANSAS TAX (See Instructions on pages 11 & 12) Add the amounts listed above and enter the total AMOUNT ARKANSAS INDIVIDUAL INCOME TAX Dividends and other distributions on stock are fully taxable There is no dividend exclusion applicable to Arkansas here and on Line 10 Form AR1000F/AR1000NR here and on Line 11 Form AR1000F/AR1000NR INTEREST AND DIVIDEND INCOME SCHEDULE 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 dividend sources and designate ownership by writing Y (Yours) S (Spouse s) or J (Joint) List below the names of the interest sources and designate ownership by writing Y (Yours) S (Spouse s) or J (Joint) Ministers Housing Allowance NAME OF PAYER Page AR4 (R 8/16/2011) Part I TAXABLE INTEREST INCOME Part II TAXABLE DIVIDEND INCOME Railroad Retirement Benefits Social Security Social Security Number TOTAL INCOME NOT SUBJECT TO ARKANSAS TAX: (Enter here and on Form AR1000F/AR1000NR Line 51) Unemployment