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Form AR1100-CO Fillable Schedule of Check-Off Contributions
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)
(: 1) Unchecked (: 1) Unchecked (: 1) Unchecked (: 1) Unchecked (: 10) Unchecked (: 10) Unchecked (: 10) Unchecked (: 10) Unchecked (: 20) Unchecked (: 20) Unchecked (: 5) Unchecked (: 5) Unchecked (: 5) Unchecked (: 5) Unchecked (: ToTRef) Unchecked (: ToTRef) Unchecked (: ToTRef) Unchecked (: ToTRef) Unchecked (: WriteIn) Unchecked (: WriteIn) Unchecked (: WriteIn) Unchecked (: WriteIn) Unchecked (Click Here to Clear the Work Sheet) Click Here to Clear Form Info (Click Here to Print Document) Click Here to Print Document (Enter the FEIN) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) [ ] $1 [ [ ] $1 [ ] $5 [ [ ] $1 [ ] $5 [ ] $10 [ ] $1 [ ] $1 [ ] $1 [ ] $5 [ ] $10 [ ] $10 [ ] $10 [ ] $10 [ ] $20 [ ] $5 [ ] $5 [ ] $5 [ ] Your Total Refund ] Your Total Refund ] Your Total Refund ] Your Total Refund ]$20 [ A ARKANSAS DISASTER RELIEF PROGRAM ADDRESS AR1100 CO AR1100CO (R 8/2015) ATTACH IMMEDIATELY AFTER SCHEDULE A OF ARKANSAS FORM AR1100CT B ARKANSAS GAME AND FISH FOUNDATION $ C ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF $ CITY STATE ZIP CORPORATION INCOME TAX RETURN D BABY SHARON S CHILDREN S CATASTROPHIC ILLNESS PROGRAM $ E ORGAN DONOR AWARENESS EDUCATION PROGRAM $ F MILITARY FAMILY RELIEF PROGRAM $ FOR TAXPAYERS THAT ARE DUE A REFUND: This schedule must be attached to any return claiming a check off contribution Enter FOR TAXPAYERS THAT OWE ADDITIONAL TAXES: Detach this schedule and submit a separate check for the amount of G AREA AGENCIES ON AGING PROGRAM $ H NEWBORN UMBILICAL CORD BLOOD INITIATIVE $ I TOTAL CHECK OFF CONTRIBUTION $ INSTRUCTIONS: Check the appropriate box and then enter the designated amount for each check off in the box provided NAME FEIN on Line 41 of the AR1100CT then your contribution will not be recognized and the amount will be refunded to you reduce your refund by a corresponding amount If this schedule is not attached to your AR1100CT or if the amount in Box I is not entered SCHEDULE OF CHECK OFF CONTRIBUTIONS STATE OF ARKANSAS the amount from Box I (Total Check Off Contribution) from this schedule on Line 41 of the AR1100CT The total amount you contribute will Total your contributions and enter the amount in Box I CONTRIBUTIONS ARE LIMITED TO WHOLE DOLLAR AMOUNTS ONLY Write in Amount Write in Amount Write in Amount Write in Amount your check off contributions Mail to: Arkansas Corporation Income Tax P O Box 919 Little Rock AR 72203 0919