Arkansas Employee Tuition Reimbursement Tax Credit

Employee Tuition Reimbursement Tax Credit
2021_AR1036_BC.pdf
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CLEAR FORM
CTTR211

AR1036

State of Arkansas

EMPLOYEE TUITION REIMBURSEMENT TAX CREDIT

Tax Year beginning ______/______/______ and ending
Name of Entity

______/______/______

FEIN/SSN
NAICS Code

Address

SECTION B

SECTION A

City

State
OWNERSHIP CLASSIFICATION

County

Zip

Telephone Number

(Check only one box)

1.

Sole Proprietorship

4.

Partnership (Complete Section D below)

2.

Taxable Corporation

5.

Limited Liability Company LLC (Complete Section D below)

3.

Fiduciary

6.

Subchapter S Corporation (Complete Section D below)

ELIGIBILITY CLASSIFICATION
7. Enter Applicable Eligibility Number (Refer to Instructions, Page 2, Item 15).......................................
(QWHU3HUFHQWDJHRI5HYHQXHIURPRXWRIVWDWHVDOHV,I(OLJLELOLW\1XPEHU%&RUHQWHUHGRQ/LQH

%

9. Enter Percentage of retail sales to general public (If Eligibility Number 2, 3, 5 or 6 entered on Line 7)

%

10. Enter average hourly wages paid (If Eligibility Number 8 or 9 entered on Line 7)..........................................

SECTION C

ELIGIBLE TAX CREDIT FOR THIS TAX YEAR
11. Total Tax Credit subject to income tax liability limitation (Enter amount from Section E, page 2, line 2) $
NOTE: ,I2ZQHUVKLS&ODVVL¿FDWLRQER[RULVFKHFNHGLQ6HFWLRQ$VNLSOLQHVDQGFRPSOHWHsection D,
  ³$OORFDWLRQRI7RWDO7D[&UHGLWIRU3DVV7KURXJK(QWLW\0HPEHUV´
12. Entity’s Income Tax Liability for This Tax Year..................................................................................... $
13. Income Tax Liability Limitation (Multiply Line 12 x 25%)..................................................................... $
14. Eligible Tax Credit available for this Tax Year only (Enter the smaller of Line 11 or Line 13).............. $
ALLOCATION OF TOTAL TAX CREDIT FOR PASS-THROUGH ENTITY MEMBERS
NOTE: Each Member’s share of total tax credit subject to 25% income tax liability limitation

SECTION D

Member’s Name

AR1036 Page 1 (R 1/27/2020)

Percentage
Of Ownership

Member’s SSN/FEIN

Member’s Share of Total
Tax Credit From Line 11

%

$

%

$

%

$

%

$

%

$

%

$

%

$

%

$

%

$

CTTR212

AR1036

State of Arkansas

EMPLOYEE TUITION REIMBURSEMENT TAX CREDIT

Tax Year beginning ______/______/______ and ending ______/______/______

Name of Entity

FEIN/SSN

SECTION E: Tuition Paid or Reimbursed by Employer
$FFUHGLWHG(GXFDWLRQDO,QVWLWXWLRQ/RFDWHGZLWKLQ$UNDQVDV
Employee’s Name

Name of Institution

City

Amount Paid
or Reimbursed

Date Tuition Paid
or Reimbursed

(round to whole dollars)

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
1. Total Amount Paid or Reimbursed.........................................................................................................1. $
2. Total Tax Credit (Multiply Line 1 X 30%, Enter results here and on Line 11, Page 1, Section C)....................2. $
AR1036 Page 2 (R 1/28/2020)