Form AR8453 Declaration for Electronic Filing , Individual Income Tax

1 Total Income (Form AR1 or NR1 Line 21) 1) The total income on line 1 differs from the amount on the electronic return by more than $25 or 2 Net Tax (Form AR2 or NR2 Line 36) 2) The total tax on Line 2 the refund on Line 4 or tax due on Line 5 differs from the amount on the electronic return by more than $7 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) 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 Account Number AR1000RC5 or Recertification Letter must be attached to the e mail Attachment: AR8453 along with the Attachment: AR8453 along with the Other State Tax Return(s)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 cen tral standard time) Check refund status Direct deposits will not be deposited into accounts outside the United States To comply with new banking rules answer the following: E mail To: AR8453@dfa arkansas gov Effective January 1 2000 ERO s are required to retain the AR8453 forms along with the original W 2 W 2G and 1099 s forms and other special forms for 3 years from the original due date of the tax return except when the AR1000RC5 or Other State Tax returns must be submitted to the State of Arkansas EROs can sign the form using a rubber stamp mechanical device (such as a signature pen) or computer software program Fax To: 501 682 7393 AR8453 along with the AR1000RC5 or Recertification Letter must be included in the fax transmission Fax To: 501 682 7393 AR8453 along with the Other State Tax return(s) must be included in the fax transmission For more information see Publication AR1345 Also go to www arkansas gov/efile 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 Provide the taxpayer with a copy of the signed Form AR8453 for his or her records upon request Provide the taxpayer with a corrected copy of Form AR8453 if changes are made to the return Routing Number Checking Savings Subject: Taxpayer name and Other State Tax Return(s) Subject: Taxpayer name and RC5 View account letters Will this refund go to an account outside the United States? Yes No You should confirm the identity of the (Registration is not required to make payments or to check refund status ) A paid preparer must sign Form AR8453 in the space for Paid Preparer s Use Only Only handwritten signatures are acceptable If the paid preparer is also the ERO he/she should not complete the paid preparer s section Instead the box labeled Check if paid preparer should be checked After the State of Arkansas has accepted your electronically filed return the refund should be issued within 7 to 10 business days AR8453 AR8453 (R 10/11/2011) AR8453 (R 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: Check Check City State and Zip Code Declaration Control Number (DCN) DECLARATION FOR ELECTRONIC FILING Direct Deposit is offered on electronically filed Ar kansas 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 coun tries: 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: DO NOT MAIL THIS FORM employed ERO S ERO S Signature Date Firm s name and address FEIN For addresses and complete instructions refer to Federal Publication 1345 Handbook for Electronic Filers of Individual Income Tax Re turns and the Arkansas Handbook AR1345 for Electronic Filers I declare that I have reviewed the above taxpayer s return and that the entries on Form AR8453 are complete and correct to the best of my knowledge If I am only a collector I understand that I am not responsible for reviewing the taxpayer s return; I declare that Form AR8453 accurately reflects the data on the return I have obtained the taxpayer s signature on Form AR8453 before submitting this return to the State of Arkansas and have provided the taxpayer with a copy of all forms and information to be filed with the State of Arkansas If I am also the Paid Preparer under penalties of perjury I declare that I have examined the above taxpayer s return and accompanying schedules and statements and to the best of my knowledge and belief they are true correct and complete This declaration of Paid Preparer is based on all information of which the preparer has knowledge 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 paid preparer if self If the ERO makes changes to the electronic return after Form AR8453 has been signed by the tax payer but before it is transmitted the ERO must have the taxpayer complete and sign a corrected Form AR8453 if either of the following apply: 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 do not have Form AR1000 V you may get it from your on line service provider and/or trans mitter You can also download it from the State of Arkansas s web site www arkansas gov/efile IMPORTANT NOTES FOR EROs 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 Originator (ERO) and Paid Preparer 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 Part III Declaration of Electronic Return PART III DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER Preparer s Preparer s Signature Date Preparer s SSN or PTIN REFUND INFORMATION 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 taxpayer(s) Telephone Number The State of Arkansas requires the EROs signa ture The taxpayer s signature allows the State of Arkan sas to disclose to the ERO and/or the transmitter the reason(s) for delays in the processing of the return Under penalties of perjury I declare that I have examined the above taxpayer s return and accompanying schedules and statements and to the best of my knowledge and belief they are true correct and complete This declaration is based on all information of which I have any knowledge Under the penalties of perjury I declare that the information I have given my ERO and the amounts in Part I above agree with the amounts on the cor responding 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 I consent to my ERO sending my return this declaration and accompanying schedules and statements to the State of Arkansas I also consent to the State of Arkansas sending my ERO and/or transmitter an acknowledgement of receipt of transmission and an indication of whether or not my return is accepted and if rejected the reason(s) for the rejection If the processing of my return or refund is delayed I authorize the State of Arkansas to disclose to my ERO and/or transmitter the reason(s) for the delay or when the refund was sent Use Only 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 WHEN AND WHERE TO FILE You can check on the status of your refund if it has been at least 72 hours since State of Arkan sas acknowledged receipt of your e filed return To check the status of your refund do one of the following Your Signature Date Your Social Security Number Your SSN or PTIN