INSTRUCTIONS: ARKANSAS EMPLOYEE'S SPECIAL WITHHOLDING EXEMPTION CERTIFICATE (Form AR4ESCP)

Arkansas employees whose gross annual income does not exceed certain limitations may file a special exemption certificate with their employer to ensure that state income tax is not withheld from their wages. This form AR4ESCP can be obtained from the website maintained by the Arkansas Department of Finance and Administration.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 1: On the first blank line, enter your full name.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 2: On the second blank line, enter your Social Security number.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 3: On the third blank line, enter your home street address.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 4: On the fourth blank line, enter your city.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 5: On the fifth blank line, enter your state.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 7: On the sixth blank line, enter your zip code.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 8: Check the block next to the first statement if you are single and your gross income from all sources combined will not exceed $10.941.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 9: Check the block next to the second statement if you are married and filing jointly with a spouse, have one or less dependents and your combined income from all sources will not be in excess of $18,449.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 10: Check the block next to the third statement if you are married, filing jointly with two or more dependents, and your combined gross income will not be in excess of $22,203.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 11: Check the block next to the fourth statement if you are an unmarried head of household or qualifying widower with one or less dependents whose income will not exceed $15,553.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 12: Check the block next to the fifth statement if you are an unmarried head of household or qualifying widower with two or more dependents whose income will not exceed $18,540.

Arkansas Employee's Special Withholding Exemption Certificate AR4ESCP Step 13: Sign and date the bottom of the form.