Arkansas Schedule of Check-Off Contributions

Schedule of Check-Off Contributions
2021_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[DQGWKHQHQWHUWKHGHVLJQDWHGDPRXQWIRUHDFKFKHFNRႇLQWKH
box provided. Total your contributions and enter the amount in Box I. CONTRIBUTIONS ARE LIMITED TO WHOLE
DOLLAR AMOUNTS ONLY.

FOR TAXPAYERS THAT ARE DUE A REFUND: 7KLVVFKHGXOHPXVWEHDWWDFKHGWRDQ\UHWXUQFODLPLQJDFKHFNRႇ
contribution. Enter the amount from Box I 7RWDO&KHFN2ႇ&RQWULEXWLRQ from this schedule on Line 40 of the AR1100CT.
The total amount you contribute will 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 on Line 40 of the AR1100CT, then your contribution will not be recognized
and the amount will be refunded to you.
FOR TAXPAYERS THAT OWE ADDITIONAL TAXES: Detach this schedule and submit a separate check for the
DPRXQWRI\RXUFKHFNRႇFRQWULEXWLRQVMail to: Arkansas Corporation Income Tax - P O Box 919, Little Rock,
AR 72203-0919
A. ARKANSAS DISASTER RELIEF PROGRAM..........................................................................
$1

$10

$5

$20
Write in Amount

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B. ARKANSAS GAME AND FISH FOUNDATION.......................................................................
$10

$5

$1

$

$

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Write in Amount

C. ARKANSAS SCHOOL FOR THE BLIND/SCHOOL FOR THE DEAF..................................
$10

$5

$1

Write in Amount

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

$10

$5

$20
Write in Amount

$10

$5

$

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E. ORGAN DONOR AWARENESS EDUCATION PROGRAM....................................................
$1

$

$

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Write in Amount

F. MILITARY FAMILY RELIEF PROGRAM....................................................................................
$1

$10

$5

$20
Write in Amount

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G. AREA AGENCIES ON AGING PROGRAM...............................................................................
$10

$5

$1

Write in Amount

$5

$10

$20

$

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H. NEWBORN UMBILICAL CORD BLOOD INITIATIVE............................................................
$1

$

$

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Write in Amount

I. TOTAL CHECK OFF CONTRIBUTION.......................................................................................
AR1100-CO (R 1/27/2020)

$