Arkansas Schedule of Check-Off Contributions

Schedule of Check-Off Contributions
2023_AR1100-CO_BC.pdf
AR1100-CO

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STATE OF ARKANSAS
SCHEDULE OF CHECK-OFF CONTRIBUTIONS
CORPORATION INCOME TAX RETURN
ATTACH IMMEDIATELY AFTER SCHEDULE A OF ARKANSAS FORM AR1100CT
Name _____________________________________________________ FEIN __________________________
Address __________________________________________________________________________________
City ______________________________________________________ State ___________ Zip ____________
INSTRUCTIONS: &KHFNWKHDSSURSULDWHER[DQGWKHQHQWHUWKHGHVLJQDWHGDPRXQWIRUHDFKFKHFNRႇLQWKHER[SURYLGHG
Total your contributions and enter the amount in%R[, CONTRIBUTIONS ARE LIMITED TO WHOLE DOLLAR AMOUNTS ONLY.
FOR TAXPAYERS THAT ARE DUE A REFUND: 7KLVVFKHGXOHPXVWEHDWWDFKHGWRDQ\UHWXUQFODLPLQJDFKHFNRႇFRQWULEXWLRQ
Enter the amount from Box I 7RWDO&KHFN2ႇ&RQWULEXWLRQIURPWKLVVFKHGXOHRQ/LQHRIWKH$5&77KHWRWDODPRXQW\RXFRQWULEXWHZLOOUHGXFH\RXUUHIXQGE\DFRUUHVSRQGLQJDPRXQW,IWKLVVFKHGXOHLVQRWDWWDFKHGWR\RXU$5&7RULIWKHDPRXQWLQ%R[,LV
QRWHQWHUHGRQ/LQHRIWKH$5&7WKHQ\RXUFRQWULEXWLRQZLOOQRWEHUHFRJQL]HGDQGWKHDPRXQWZLOOEHUHIXQGHGWR\RX
FOR TAXPAYERS THAT OWE ADDITIONAL TAXES: Detach this schedule and submit a separate check for the amount of
\RXUFKHFNRႇFRQWULEXWLRQV Mail to: Arkansas Corporation Income Tax - P O Box 919, Little Rock, AR 72203-0919
A. ARKANSAS DISASTER RELIEF PROGRAM.
$1

$5

$10

$20
Write in Amount

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B. ARKANSAS GAME AND FISH FOUNDATION.
$1

$5

$10

$20

$

$

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Write in Amount

C. ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF.
$1

$5

$10

$20

Write in Amount

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D. BABY SHARON’S CHILDREN’S CATASTROPHIC ILLNESS PROGRAM.
$1

$5

$10

$20
Write in Amount

$5

$10

$20

$5

$10

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$20
Write in Amount

$5

$10

$20
Write in Amount

$5

$10

Write in Amount

$5

$10

$20

$

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Write in Amount

J. TOTAL CHECK OFF CONTRIBUTION.
AR1100-CO (R 6/29/2023)

$

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$20

I. LAW ENFORCEMENT FAMILY RELIEF TRUST FUND.
$1

$

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H. NEWBORN UMBILICAL CORD BLOOD INITIATIVE.
$1

$

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G. AREA AGENCIES ON AGING PROGRAM.
$1

$

Write in Amount

F. MILITARY FAMILY RELIEF PROGRAM.
$1

$

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E. ORGAN DONOR AWARENESS EDUCATION PROGRAM.
$1

$

$