Form AR8453-OL Declaration for Online Electronic Filing

1 Total Income (Form AR1 or NR1 Line 21) 2 Net Tax (Form AR2 or NR2 Line 36) 3 State Income Tax Withheld (Form AR2 or NR2 Line 37) 4 Refund (Form AR2 or NR2 Line 45) 5 Tax Due (Form AR2 or NR2 Line 49) Account Number All W 2(s) and 1099(s) must be attached to the AR8453 OL Attachment: AR8453 OL along with the Attachment: AR8453 OL along with the Other State Tax returns must be attached to the e mail Call 501 682 1100 or 1 800 882 9279 (Monday through Friday from 8:00 a m to 4:30 p m central standard time) Check refund status Direct deposits will not be deposited into accounts outside the United States E mail To: AR8453@dfa arkansas gov Fax To: 501 682 7393 AR8453 along with the Other State Tax return(s) must be included in the fax transmission Fax To: 501 682 7393 AR8453 OL along with the AR1000RC5 or Recertification Letter must be included in the fax transmission Go to www arkansas gov/dfa Click on Income Tax Refund Inquiry Little Rock AR 72203 8094 Mail To: Arkansas Electronic Filing Group Make name and address changes Make payments P O Box 8094 Routing Number Checking Savings Subject: Taxpayer name and Other State Tax Return Subject: Taxpayer name and RC5 To comply with new banking rules answer the following: View account letters Will this refund go to an account outside the United States? Yes No (Registration is not required to make payments or to check refund status ) (see instructions) 6a I consent that my refund be directly deposited as designated in the electronic portion of my 2011 Arkansas income tax return If I have filed a joint return this is an irrevocable appointment of the other spouse as an agent to receive the refund 6b I do not want direct deposit of my refund or I am not receiving a refund After the State of Arkansas has accepted your elec tronically filed return the refund should be issued within 7 to 10 business days AR1000RC5 or Recertification Letter must be attached to the e mail AR8453 OL AR8453 OL (R 10/11/2011) AR8453 OL (Rev 8/23/2011) ARKANSAS ATAP (Arkansas Taxpayer Access Point) allows taxpayers or their representatives to log on to a secure site and manage their account online You can access ATAP at www atap arkansas gov Some features are listed below: City State and Zip Code Declaration Control Number (DCN) DECLARATION FOR ELECTRONIC FILING Direct Deposit is offered on electronically filed Arkansas Individual Income Tax returns with United States address only including Hawaii and Alaska You must use the same account that is being used for the direct deposit of your Federal refund If the Federal return is a tax due your State refund can be direct deposited if supported by your software DIRECT DEPOSITS Direct deposits are not offered to those filing with either a foreign address or an account outside the United States This includes the following countries: Guam Virgin Islands and Puerto Rico Do Not attach your check or money order to Form AR8453 OL Do not mail a copy of your AR1000F/AR1000NR Mail your payment with Form AR1000 V on or before April 17 2012 to: If I have filed a balance due return I understand that if the state of Arkansas does not receive full and timely payment of my tax liability I will remain liable for the tax liability and all applicable interest and penalties If I have filed a joint federal and state return and my federal return is rejected I understand my state return will be rejected also If Line 6a is marked you ve chosen to have your state refund direct deposited into the account shown on the form under Routing and Account Number See Refund Information in next column If Line 6b is marked you ve chosen to have your state refund mailed to the address shown above If the taxpayer is claiming the Individuals with Developmental Disabilities credit the AR1000RC5 or recertification letter must be sent to the E File Section by one of the methods below: If the taxpayer is claiming the Other State Tax Credit the Other State Tax return(s) must be sent to the E File Section by one of the methods below: If you choose to file your State of Arkansas tax return by using one of the online web providers you are required to complete the AR8453 OL You must keep the completed and signed AR8453 OL along with your tax return and any W 2 s and/or 1099 s If you have claimed the Individuals with Developmental Disabilities Credit or Other State Tax Credit see the instructions below: If you do not have Form AR1000 V you may get it from your on line service provider and/or transmitter You can also download it from the State of Arkansas s web site www arkansas gov/efile INDIVIDUAL INCOME TAX Individuals with Developmental Disabilities Credit Last Name Line 3 Enter the total State of Arkansas withhold ing from Form(s) W 2 and/or 1099 LINE INSTRUCTIONS Little Rock AR 72203 8149 Mailing Address Name Address and Social Security Number Note: Attachments must be in one of the fol lowing formats: tif pdf bmp jpg or jpeg Note: The address must match the address shown on the electronically filed Form AR1000F Other State Tax Credit P O Box 8149 Part I Tax Return Information PART I TAX RETURN INFORMATION (Whole Dollars Only) Part II Declaration of Taxpayer REFUND INFORMATION Retain this form with your tax return SPECIAL INFORMATION Spouse s Name and Initial Spouse s Signature Date Spouse s Social Security Number State Income Tax E File Payment TAX DUE Taxpayer Name and Initial Telephone Number This form may be needed when submitting documentation to the State of Arkansas for Tax Year 2011 Under the penalties of perjury I declare that the information I have provided and the amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 2011 Arkansas income tax return To the best of my knowledge and belief my return is true correct and complete Verify the Name(s) Address and Social Security Number(s) are correct An incorrect or missing social security number may delay any refund If filing a joint return be sure the names and social security numbers are listed in the same order You can check on the status of your refund if it has been at least 72 hours since State of Arkansas acknowledged receipt of your e filed return To check the status of your refund do one of the following You must sign the AR8453 OL If filing a joint return your spouse must also sign the AR8453 OL Your Signature Date Your Social Security Number