STATE OF ARKANSAS 
                                                    INFORMATION RETURN 
AR1099PT                                      Report of Income Tax Withheld or Paid 
                                              on Behalf of Nonresident Member 

                                          Tax Year End of Pass Through Entity 
                                                                                                  mm/dd/yyyy

Part A: Pass - Through Entity Information                                       Part B: Nonresident Member Information
Name of Entity:                                                                 Name:

Type of Ownership: (if other, please provide statement of ownership type)       Type of Ownership: (if other, please provide statement of ownership type)
Partnership       C Corp.      S Corp.    LLC Trust Other                             Partnership C Corp. S Corp.   LLC   Trust Individual               Other
Federal Identification Number:                                                  Social Security Number or Federal Identification Number of Member:

Street Address:                                                                 Street Address:

City, State, ZIP:                                                               City, State, ZIP:

Part C: Distribution and Tax Withholding or Payment Information for Nonresident Member
Amount Distributed from Arkansas Sources: Arkansas Income Tax Withheld:         Arkansas Income Tax Paid on AR1000CR: Arkansas Income Tax Paid on AR1100PET:

                                                                          STATE OF ARKANSAS 
                                                    INFORMATION RETURN 
AR1099PT                                      Report of Income Tax Withheld or Paid 
                                              on Behalf of Nonresident Member 

                                          Tax Year End of Pass Through Entity 
                                                                                                  mm/dd/yyyy

Part A: Pass - Through Entity Information                                       Part B: Nonresident Member Information
Name of Entity:                                                                 Name:

Type of Ownership: (if other, please provide statement of ownership type)       Type of Ownership: (if other, please provide statement of ownership type)
Partnership       C Corp.      S Corp.    LLC Trust                       Other       Partnership C Corp.   S Corp.   LLC Trust Individual               Other
Federal Identification Number:                                                  Social Security Number or Federal Identification Number of Member:

Street Address:                                                                 Street Address:

City, State, ZIP:                                                               City, State, ZIP:

Part C: Distribution and Tax Withholding or Payment Information for Nonresident Member
Amount Distributed from Arkansas Sources:  Arkansas Income Tax Withheld:        Arkansas Income Tax Paid on AR1000CR: Arkansas Income Tax Paid on AR1100PET:

                                                                                                                                AR1099PT (Revised 03/11/2024)

                                       Instructions for AR1099PT

PASS THROUGH ENTITY 
  
WHO MUST FILE AN AR1099PT: 
  
Any pass through entity that withholds Arkansas income tax from a distribution to a nonresident member and/or files a 
Composite Return (AR1000CR) on behalf of its nonresident members. The amount reported on the AR1099PT must equal 
the amounts reported on the AR1000CR or AR1100PET and AR941PT. Attach a copy to the AR1000CR or AR1100PET if 
necessary to substantiate withholding. 
  
WHERE DO YOU SEND THE AR1099PT: 
  
Send two (2) copies to the nonresident member and retain one (1) for your records. Do not remit a copy to the Individual 
Income Tax Section unless requested.  
  
WHEN DO YOU FILE THE AR1099PT: 
  
You must send two (2) copies to the nonresident member by the 15th day of the third month of the close of your tax year 
(March 15 for calendar year filers). 
  
NONRESIDENT MEMBER 
  
Include the AR1099PT with your Arkansas income tax return to substantiate the tax withheld or paid on your behalf.

                                       Instructions for AR1099PT

PASS THROUGH ENTITY 
  
WHO MUST FILE AN AR1099PT: 
  
Any pass through entity that withholds Arkansas income tax from a distribution to a nonresident member and/or files a 
Composite Return (AR1000CR) on behalf of its nonresident members. The amount reported on the AR1099PT must equal 
the amounts reported on the AR1000CR or AR1100PET and AR941PT. Attach a copy to the AR1000CR or AR1100PET if 
necessary to substantiate withholding. 
  
WHERE DO YOU SEND THE AR1099PT: 
  
Send two (2) copies to the nonresident member and retain one (1) for your records. Do not remit a copy to the Individual 
Income Tax Section unless requested.  
  
WHEN DO YOU FILE THE AR1099PT: 
  
You must send two (2) copies to the nonresident member by the 15th day of the third month of the close of your tax year 
(March 15 for calendar year filers). 
  
NONRESIDENT MEMBER 
  
Include the AR1099PT with your Arkansas income tax return to substantiate the tax withheld or paid on your behalf.

                                                                AR1099PT (Revised 03/11/2024)