State of Arkansas Individual Income Tax Penalty Waiver Request

The State of Arkansas Individual Income Tax Penalty Waiver Request consists of three main parts. The taxpayer information, penalty waiver request, and signature.

Extracted Text for Proper Search

SECTION II - PENALTY WAIVER REQUEST
Check all that apply:	 	Failure to File Penalty	 	Failure to Pay Penalty	 	UEP (Under Estimate Penalty)	 	
For T
ax Year(s):
Reason for Request (check all that apply):	
 	Illness	 	Natural Disaster	 	Other	
Please explain in detail why your penalty should be waived:
SECTION I - TAXPAYER INFORMATION
1 <RXU	1DPH	�UVW	QDPH	LQLWLDO	DQG	ODVW	QDPH 2	 	Your Social Security Number
3	
 Spouse’s Name 	
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QDPH	LQLWLDO	DQG	ODVW	QDPH 4	 	Spouse’s Social Security Number
5	

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6	
 Daytime Phone Number
7
 E-mail Address	
STATE OF ARKANSAS	
Individual Income Tax
Penalty Waiver Request	
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SECTION III - SIGNATURE	
Your Signature	 	Date	 	Daytime Phone Number
,I	
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MAIL COMPLETED FORM TO:
ARKANSAS STATE INCOME TAX PO BOX 3628
LITTLE ROCK, AR 72203