Form AR1000ADJ Fillable Adjustments Schedule
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

$2 150 maximum deductible is $3 200 and the $2 500 and the maximum out of pocket expense $4 000 per year (2) for family coverage the minimum deductible (2) for family coverage the minimum deductible is (A) Your/Joint (account holder) and the taxpayer s spouse (AGI) before the IRA deduction as shown in the (AR TX Form is supplied by your employer ) (B) Spouse s (C) Arkansas (IRA) If you contributed to your own IRA (MSA) An MSA is a trust or custodial account that (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Name) (Social Security Number) (sole proprietor) Schedule F (farm) Schedule 1 Border city exemption: (Attach Form AR TX) 1 1 through 16 and enter on this line and on Forms 1 You paid interest in 2013 on a qualified student 10 KEOGH Self employed SEP and Simple Plans: 10 11 Forfeited interest penalty for premature withdrawal: 11 12 Alimony/Sep Maint paid to: Name: SSN: 12 13 Support for individuals with permanent disabilities: (Attach Form AR1000DC) 13 14 Organ Donor Deduction: (Attach Form AR1000OD) 14 15 Military Reserve Expenses: 15 16 Reforestation Deduction: 16 17 TOTAL OTHER ADJUSTMENTS: (Enter here and on AR1000F/AR1000NR Line 22) 17 2 Arkansas Tax Deferred Tuition Savings Program: (See Instructions) 2 2 Your filing status is any status other than married 3 or 6; $155 000 if filing Status 2 or 4 Status 4 3 Payments to IRA: (See Instructions) 3 3 Your AGI is less than: $75 000 if filing Status 1 4 Payments to MSA: (See Instructions) 4 4 You are not claimed as a dependent on another 5 Payments to HSA: (See Instructions) 5 6 Deduction for interest paid on student loans: (See Instructions) 6 7 Contributions to Intergenerational Trust: (See Instructions) 7 8 Moving expenses: (Attach federal Form 3903) 8 9 Self employed health insurance deduction: (See Instructions) 9 a plan the amount of the deduction depends Additional information may be required for Adjustments Adjustments age 55 by the end of the tax year can increase their allowable deduction Catch up Contributions along with your Arkansas AGI to determine your an adjustment from income of $500 for each individual and the amount was included on your W 2 report and/or dependents To be eligible a taxpayer annual contribution by $1 000 for 2013 Maximum annual contribution by up to $1 000 apply: AR1000ADJ (R 10/10/13) AR1000ADJ (R 10/11/13) AR1000ADJ 2013 AR1000ADJ INSTRUCTIONS AR1000F or AR1000NR Line 22 AR1000NR Line 8 Archer MSAs may not be established after 2007 Arkansas and cannot distribute any of the trust ARKANSAS INDIVIDUAL INCOME TAX Arkansas or Texarkana Texas If you use a Post Arkansas you are allowed a full exemption as the result of a court order enter the be exempt from Arkansas income tax with respect but contributions can be made to existing accounts can deduct certain moving expenses incurred certain limitations may apply to the amount you claim the deduction only once in his or her lifetime contribution limitation for any month is the amount contribution to a Health Savings Account (HSA) contribution to an Archer Medical Savings account contribution to an Individual Retirement Account contributions allowed to an HSA are reduced by any contributions made to an Archer MSA cover health care costs Individuals who reached coverage the minimum deductible is $1 250 and coverage under a HDHP only A HDHP will have the deductible health plan (HDHP) only A HDHP will deductible The deductible contribution cannot deductible up to $5 500 each for all filing statuses determine your deduction E (rents royalties partnerships etc ) or retirement earned while a resident of Texarkana Arkansas enter the total amount Enter the total of each column on Line 17 of this form and on Line 22 of AR1000F or AR1000NR equal to 1/12 of 65% of the annual deductible for an established under the Arkansas Tax Deferred exceed $5 000 per taxpayer per tax year Qualified federal Form 3903 ) Figure your allowable deduction using the worksheet filers note that this is a combined income amount filing separately on different returns (Status 5) filing statuses must complete column (A) only following deductions and limitations: (1) for self only for self only coverage the minimum deductible is for yourself or one of your dependents related to from a deceased donor Attach Form AR1000 OD from Arkansas income tax Part year Texarkana Full Year Nonresident Filers Complete columns (A) and (B) if using filing status 4 (married filing separately on the same return) All Full Year Resident Filers Complete columns (A) and (B) if using filing status 4 (married filing separately on the same return) All other funds to the beneficiary until the beneficiary have the following deductions and limitations: (1) If either you or your spouse was covered by such If you lived in the city limits of Texarkana Texas If you lived within the city limits of Texarkana If you were reimbursed for any moving expenses in 2013 in states other than Arkansas are not income is allowed income is taxable to you income such as interest dividends Schedule C individual with self only coverage and 1/12 of 75% Individuals who turned 50 before the close of the INSTRUCTIONS is $12 500 You can make pre tax contributions is $4 300 maximum deductible is $6 450 and the is created or organized exclusively for the purpose kidney intestine lung or bone marrow) you may limits of Texarkana Arkansas All other Arkansas LINE 1 To claim the Texarkana exemption you LINE 10 If you were self employed and contributed LINE 11 Enter the total penalties paid for early LINE 12 If you paid alimony or separate maintenance LINE 13 If you have an individual with disabilities LINE 14 If you paid unreimbursed expenses LINE 15 If you have military reserve expenses LINE 16 If you have reforestation deductions LINE 17 Total Other Adjustments Add Lines LINE 2 If you made contributions to a tuition LINE 3 This line is used to report your allowable LINE 4 This line is used to report your allowable LINE 5 This line is used to report your allowable LINE 6 You may take an adjustment for interest LINE 7 You may take an adjustment for contributions LINE 8 Employees and self employed persons LINE 9 If you were self employed and had a made to a long term intergenerational maximum out of pocket expense is $4 300 and maximum out of pocket expense is $7 850 The may use as an adjustment to income If neither miles to the distance from your old home to your must be claimed for the year in which the transplantation must file a return and report all Arkansas income must file using their street address in Texarkana must have had insurance coverage under a high Name Social Security Number net profit for 2013 you may be able to deduct new workplace must be at least 50 miles from NOTE: Do not enter amounts from categories that are not printed on this form See instructions for additional information NOTE: Taxpayers who claim this exemption Number of the person you paid occurs Allowable expenses include of paying the qualified medical expenses of the taxpayer of the annual deductible for family coverage New of up to $3 250 each year ($6 450 for families) to Office Box this exemption will not be allowed on page 21 of the booklet on the amount of your Adjusted Gross Income or a SIMPLE plan enter the total contributions other filing statuses must complete column (A) only Enter only the amount of adjustments attributable to Arkansas in column (C) other filing statuses must complete column (A) only If an amount is entered in column (C) attach explanation paid on student loans if all of the following part of the amount paid for health insurance for Part Year Resident Filers Complete columns (A) and (B) if using filing status 4 (married filing separately on the same return) All provided retirement plan the entire contribution is reaches age 55 Contributions are limited to related to the organ donation An individual may residents claim the exemption only on income retirement The trustee must be a resident of savings account established under the Arkansas savings program established by another state will SCHEDULE OF ADJUSTMENTS See additional instructions on the reverse side of this form Status 4 Only table on page 21 of the booklet Use this table take a tax deduction up to $10 000 The deduction Tax Deferred Tuition Savings Program enter tax year may increase the maximum permitted taxpayer s 2013 tax return the amount here Contributions to plans established The amount of the deduction depends upon the The AR TX Form is not required for non wage The deduction does not apply to organs harvested the donation of an organ (part of a liver pancreas the maximum out of pocket expense is $6 250 and the worksheet on page 22 of the booklet to this amount as income on Form AR1000F/ to a Keogh H R 10 retirement plan To be eligible a taxpayer must have had insurance to the designated beneficiary s income total amount Enter the name and Social Security travel lodging medical expenses and lost wages trust This is a trust established for an individual Tuition Savings Program or a tax deferred tuition type of plan under age 18 to provide funds for the minor s verification if an adjustment for these types of who qualifies for the deduction you can take with disabilities Attach Form AR1000DC withdrawal of certificates of deposit withdrawals from a tuition savings account workplace If you had no former workplace your You can take this deduction if you moved for you may deduct the income you earned in the city you nor your spouse was covered by an employer you received during the year Attach AR TX Form your job or business and added at least fifty 50 your old home (Attach a completed copy of yourself your spouse and/or dependents Complete