Form AR1113 "Phenylketonuria Disorder and Other Metabolic Disorders Credit" - Arkansas

What Is Form AR1113?

This is a legal form that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 24, 2017;
  • The latest edition provided by the Arkansas Department of Finance & Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form AR1113 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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Download Form AR1113 "Phenylketonuria Disorder and Other Metabolic Disorders Credit" - Arkansas

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PRINT FORM
CLEAR FORM
AR1113
2017
ARKANSAS INDIVIDUAL INCOME TAX
PHENYLKETONURIA DISORDER AND OTHER
METABOLIC DISORDERS CREDIT
Taxpayer’s Name
Taxpayer’s Social Security Number
Dependent’s Name
Dependent’s Social Security Number
A credit of up to $2,400.00, per year, per child, is allowed to individuals or to families with a dependent child or children
with Phenylketonuria (PKU), Galactosemia, Organic Acidemias, and Disorders of Amino Acid Metabolism for expenses
incurred for the purchase of medically necessary foods and low protein modified food products. Any unused credit amount
may be carried forward for an additional two (2) years. This form must be completed in its entirety to receive the credit.
Complete one form for each child with an allowable disorder.
1. Enter the total cost paid in 2017 for medically necessary foods and
00
low protein modified food products: .........................................................................................................1
00
2. Unused credit from 2015 and 2016: .........................................................................................................2
00
3. Total credit available for 2017: (Add Lines 1 and 2) .................................................................................3
$2,400
00
4. Maximum allowable credit: .......................................................................................................................4
00
5. Your total allowable credit: (Enter the smaller of Line 3 or 4) ...................................................................5
6. Enter net tax due (Line 36, Form AR1000F/AR1000NR) after
00
deducting all credits except business incentive credits and this credit: .................................................6
00
7. Credit allowed: (Enter the smaller of Line 5 or 6 here and on Line 4, AR1000TC) ..................................7
PLEASE SIGN HERE:
Under penalties of perjury, I declare that the above individual has been diagnosed with phenylketonuria
disorder and the information entered is true and correct.
Taxpayer
Date
Spouse (if applicable)
Date
AR1113 (R 5/24/2017)
PRINT FORM
CLEAR FORM
AR1113
2017
ARKANSAS INDIVIDUAL INCOME TAX
PHENYLKETONURIA DISORDER AND OTHER
METABOLIC DISORDERS CREDIT
Taxpayer’s Name
Taxpayer’s Social Security Number
Dependent’s Name
Dependent’s Social Security Number
A credit of up to $2,400.00, per year, per child, is allowed to individuals or to families with a dependent child or children
with Phenylketonuria (PKU), Galactosemia, Organic Acidemias, and Disorders of Amino Acid Metabolism for expenses
incurred for the purchase of medically necessary foods and low protein modified food products. Any unused credit amount
may be carried forward for an additional two (2) years. This form must be completed in its entirety to receive the credit.
Complete one form for each child with an allowable disorder.
1. Enter the total cost paid in 2017 for medically necessary foods and
00
low protein modified food products: .........................................................................................................1
00
2. Unused credit from 2015 and 2016: .........................................................................................................2
00
3. Total credit available for 2017: (Add Lines 1 and 2) .................................................................................3
$2,400
00
4. Maximum allowable credit: .......................................................................................................................4
00
5. Your total allowable credit: (Enter the smaller of Line 3 or 4) ...................................................................5
6. Enter net tax due (Line 36, Form AR1000F/AR1000NR) after
00
deducting all credits except business incentive credits and this credit: .................................................6
00
7. Credit allowed: (Enter the smaller of Line 5 or 6 here and on Line 4, AR1000TC) ..................................7
PLEASE SIGN HERE:
Under penalties of perjury, I declare that the above individual has been diagnosed with phenylketonuria
disorder and the information entered is true and correct.
Taxpayer
Date
Spouse (if applicable)
Date
AR1113 (R 5/24/2017)