Form AR1103 Fillable Application to be a Small Business Corporation
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(checkbox) Unchecked (checkbox) Unchecked (checkbox) 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 Date in mm/dd/yyyy format) (Enter Date in mm/dd/yyyy format) (Enter Date in mm/dd/yyyy format) (Enter the FEIN) (Enter the NAICS Code) (if applicable) See instructions (Please Print or Type) (Required) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) A corporation may elect Subchapter S treatment for Arkansas income tax purposes only if it has elected Subchapter S treatment for federal Address AR1103 (R 6/2015) AR1103 STATE OF ARKANSAS be valid all shareholders must signify their Beginning (MM/DD/YYYY) Code of each Shareholder complete statements consent by signing below (Required) Corporation s Telephone Number Date Began Business in AR Date of Federal S Election Date of Incorporation Department of Finance and Administration on forms prescribed by the Director Election By Small Business Corporation Election is to be Effective for AR Tax Year Email Federal Employer Identification Number (FEIN) income tax purposes for the same tax year The Arkansas election with each shareholder s consent shall be filed with the Director of the Incomplete Elections will be denied and will delay approval Mail Completed Form to: Corporation Income Tax Section P O Box 919 Little Rock AR 72203 0919 NAICS Code Name Address City State and Zip Name and Title of Officer or Legal Representative who the State may call for Additional Information Name of Corporation (Please print or type) NOTE: For this election to be valid the consent of each stockholder must be shown on this form If additional space is needed attach an AR1103 of Shareholder or FEIN Offi cer s Signature Offi cer s Title See Instructions Important Notes Shareholder Information Social Security Number Shareholder s signature For this election to Shares or% OwnedCheck if familymemberDate(s)AcquiredState ofResidenceDo Not write in shaded areas Signature Date State State of Incorporation supplemental consent form or an additional schedule Attach a copy of the IRS NOTICE OF ACCEPTANCE AS AN S CORPORATION to Form AR1103 Telephone number of Officer or Legal Representative Under penalties of perjury I declare this Election is duly authorized and that the statements made to the best of my knowledge and belief are true correct and Zip Code