"Individual Income Tax Penalty Waiver Request" - Arkansas

Individual Income Tax Penalty Waiver Request is a legal document that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas.

Form Details:

  • Released on August 25, 2017;
  • The latest edition currently provided by the Arkansas Department of Finance & Administration;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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REVENUE DIVISION
Individual Income Tax
STATE OF ARKANSAS
1816 W 7th St., Room 2300
Individual Income Tax
Post Office Box 3628
Little Rock, Arkansas 72203-3628
Penalty Waiver Request
Phone: (501) 682-1100
Fax: (501) 682-7692
http://www.dfa.arkansas.gov
Please type or print when filling out this form
SECTION I - TAXPAYER INFORMATION
1
2
Your Name (First Name, MI, and Last Name)
Your Social Security Number
3
4
Spouse’s Name (First Name, MI, and Last Name)
Spouse’s Social Security Number
5
Mailing Address, City, State, and Zip Code
6
Daytime Phone Number
7
E-mail Address
SECTION II - PENALTY WAIVER REQUEST
Check all that apply:
Failure to File Penalty
Failure to Pay Penalty
UEP (Under Estimate Penalty)
For Tax Year(s):
Reason for Request (check all that apply):
Illness
Natural Disaster
Other
Please explain in detail why your penalty should be waived:
SECTION III - SIGNATURE
Your Signature
Date
Daytime Phone Number
If Joint Return, Spouse’s Signature
Date
Daytime Phone Number
Penalty Waiver (R 8/25/2017)
MAIL COMPLETED FORM TO:
FAX COMPLETED FORM TO:
OR
ARKANSAS STATE INCOME TAX
501-682-7692
PO BOX 3628
LITTLE ROCK, AR 72203
REVENUE DIVISION
Individual Income Tax
STATE OF ARKANSAS
1816 W 7th St., Room 2300
Individual Income Tax
Post Office Box 3628
Little Rock, Arkansas 72203-3628
Penalty Waiver Request
Phone: (501) 682-1100
Fax: (501) 682-7692
http://www.dfa.arkansas.gov
Please type or print when filling out this form
SECTION I - TAXPAYER INFORMATION
1
2
Your Name (First Name, MI, and Last Name)
Your Social Security Number
3
4
Spouse’s Name (First Name, MI, and Last Name)
Spouse’s Social Security Number
5
Mailing Address, City, State, and Zip Code
6
Daytime Phone Number
7
E-mail Address
SECTION II - PENALTY WAIVER REQUEST
Check all that apply:
Failure to File Penalty
Failure to Pay Penalty
UEP (Under Estimate Penalty)
For Tax Year(s):
Reason for Request (check all that apply):
Illness
Natural Disaster
Other
Please explain in detail why your penalty should be waived:
SECTION III - SIGNATURE
Your Signature
Date
Daytime Phone Number
If Joint Return, Spouse’s Signature
Date
Daytime Phone Number
Penalty Waiver (R 8/25/2017)
MAIL COMPLETED FORM TO:
FAX COMPLETED FORM TO:
OR
ARKANSAS STATE INCOME TAX
501-682-7692
PO BOX 3628
LITTLE ROCK, AR 72203