INSTRUCTIONS: ARKANSAS CERTIFICATE FOR DEVELOPMENTALLY DISABLED INDIVIDUAL (Form AR1000RC5)

To claim a $500 Arkansas tax credit for taking care of a developmentally disabled individual, a form AR1000RC5 should be filed. This document can be obtained from the website maintained by the Arizona Department of Finance and Administration.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 1: In the first box, enter the name of the taxpayer.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 2: In the second box, enter the Social Security number of the taxpayer.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 3: In the third box, enter the name of the taxpayer's spouse, if applicable.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 4: In the fourth box, enter the Social Security number of the taxpayer's spouse, if applicable.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 5: On the first blank line of line 4, enter the name of the qualifying developmentally disabled individual.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 6: On the second blank line, enter the Social Security number of the qualifying developmentally disabled individual.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 7: On the third blank line, enter the relationship of the qualifying developmentally disabled individual to the taxpayer.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 8: Indicate with a check mark whether the individual spent more than six months of the year in your home.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 9: Indicate with a check mark whether the diagnosis is cerebral palsy, epilepsy, autism or intellectual disability. If the latter, enter the IQ of the qualifying developmentally disabled individual or check the box next to to "mild," "moderate" or "severe" as applicable.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 10: The first blank line at the bottom of the page should be signed by a doctor or examiner. On the second blank line they should give the date.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 11: On the third blank line, print the doctor or examiner's name. On the fourth blank line, give their telephone number.

Arkansas Certificate For Developmentally Disabled Individual AR1000RC5 Step 12: On the next four lines, give their street address, city, state and zip code. Sign and date the last two blank lines.