INSTRUCTIONS: ARKANSAS CLAIM FOR LOW-INCOME ELECTRICITY CUSTOMER SALES TAX EXEMPTION (Form E-416)

Arkansas households whose total income is no greater than $12,000 can file a claim for a sales tax exemption on the first 500 kilowatt hours per month. To file this claim, use a form E-416. This document can be obtained from the website of the Arkansas Department of Finance and Administration.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 1: On the first blank line, enter your name and Social Security number.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 2: On the second blank line, enter your electric service account number.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 3: If filing jointly with your spouse, enter their name and Social Security number on the third blank line.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 4: Enter your street address or P.O. box number, apartment number or rural address (if applicable), city, state and zip code on the fourth blank line.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 5: On lines a through l, two columns are provided. Your income should be entered in the column on the left, while income from your spouse, if applicable, should be entered in the column on the right.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 6: Enter income from Social Security income of all types on line a, from veterans pensions' or disabilitiy payments on line b, salaries and income from farms or self-employment on line c, and income from railroad retirement benefits on line d.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 7: Enter income from interest income on line e, from dividends on line g, from rent and royalties income on line h, and from the sale of realty, stocks and bonds on line i.

Arkansas Claim For Low-Income Electricity Customer Sales Tax Exemption E-416 Step 8: Enter benefits from retirement benefits or pensions for state teachers, public employees, state employees, state police and highway department members on line j. Enter income from cash assistance and relief on line k`, and all miscellaneous income on line l. Enter the total of all income where indicated. Sign and date the bottom of the page.