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(800) 882 9275
(Click Here to Clear the Work Sheet) Click Here to Clear Form Info
(If you make your request in person you may pay with cash Bring exact change )
(You must be using Adobe Reader ver 6 or above ) Click Here to Print Document
applicable) return(s) and/or W 2(s) you are requesting
AR4506
AR4506 (R 10/11/13)
attach an authorization document
completed by a paid preparer he/she should be able to provide a copy of the return Your employer
Copies are $2 00 per year Attach a check or money order DO NOT SEND CASH IN THE MAIL
Current Mailing Address (City State & Zip)
Date Secondary Signature (If Applicable) Date
Daytime Phone Number
In order to process your request signatures are required below For entities other than individuals you must
Individual Income Tax 1816 W 7th Street Room 2300
INSTRUCTIONS
Little Rock AR 72203 3628 (501) 682 1100 or
Mail this form with your payment to the mailing address or deliver to the physical address at the top of this form
Mail To:
NOTE You may be able to get your tax information from other sources If you had your tax return
OF ARKANSAS TAX RETURNS AND W 2S
Or Bring To:
P O Box 3628 Little Rock AR 72201
partner guardian tax matters partner executor receiver administrator trustee or party other than the taxpayer I certify that I have
Primary Name On Return
Primary Signature
PRINT
Print or type your name mailing information SSN FEIN (if applicable) Account ID spouse s information (if
REQUEST FOR COPIES
Return(s) Requested (List Tax Year(s))
Secondary Name On Return (If Applicable)
should be able to provide a copy of your W 2
Signature of taxpayer(s) I declare that I am either the taxpayer whose name is shown above or a person authorized to obtain the
SSN FEIN or ID Number
SSN or ID Number
STATE OF ARKANSAS
State of Arkansas Joel Y Ledbetter Building
tax information requested If the request applies to a joint return either husband or wife must sign If signed by a corporate officer
the authority to execute Form AR4506 on behalf of the taxpayer
Title (if primary name is a partnership or trust)
W 2(s) Requested (List Tax Year(s))
