STATE OF ARKANSAS 
AR4P                          Employee’s Withholding Certificate 
                              For Pensions and Annuity Payments 

Name                                                                                                           Social Security Number 

Home Address (number and street or rural route)                                                                Claim or identification number (if any) of 
                                                                                                               your pension or annuity contract 
City, State and ZIP 

CHECK HERE if you do not want any Arkansas income tax withheld from your pension or annuity. (Do               not complete lines 1                                                through 5) 

1. CHECK ONE OF THE FOLLOWING and enter amount of allowances claimed.
                        No allowances or dependents claimed. (Enter zero on lines 1, 2, and 3) 
                        Single and you claim yourself. (Enter one allowance) 
                        Married and you claim yourself and your spouse. (Enter two allowances) 
                        Head   Household, and you claim yourself. of (Enter two allowances) ......................................................................1 
2.  NUMBER     OF CHILDREN or DEPENDENTS. (Enter one allowance per dependent) ........................................................................2 

3. TOT  AL ALLOWANCES. (Add Lines 1 and     no allowances or dependents are claimed, enter zero) 2. If .............................................3 

4.  Additional amount, if any  you want deducted from each pension or annuity payment. , (Enter dollar amount) ...................................4 
5.  I qualify for the low-income tax rates. (See below for details) .............................................................................................................5 

  Please check filing status:               Single           Married Filing Jointly            Head of Household 

I certify that the number of allowances and dependents claimed on this certificate does not exceed the number to which I am entitled. 
Signature:                                                                                                                  Date:    

                                                   Instructions for Completing the 
                        Withholding Certificate for Pension and Annuity Payments 
Generally, Arkansas  income  tax  withholding  applies  to  the      taxable        3. CHANGES IN ALLOWANCES – You may file a new certificate at
portion of payments made from pension, profit-sharing, stock bonus, an-             any time if the number of allowances INCREASES. You must file a new
nuity, and certain deferred compensation plans; from individual retirement          certificate within 10 days if the number of allowances previously claimed
arrangements (IRAs); and from commercial annuities.  The first $6,000 per           by you DECREASES for any of the following reasons:
year of a pension distribution or qualified traditional IRA distribution may           (a)  Your spouse for whom you have been claiming an allowance is
be tax exempt. Also, qualified distributions from a Roth IRA are nontaxable                 divorced or legally separated, or claims his or her own allowance
and, therefore, not subject to withholding.                                                 on a separate certificate, or
                                                                                       (b)  The support of a dependent for whom you claimed an allowance
1. NUMBER OF ALLOWANCES – Do not claim more than the correct                                is expected to be less than half of the total support for the year.
number of allowances. However, if you expect to owe more income tax for                     OTHER  DECREASES  in  allowances,  such  as  the  death  of  a
the year, you may increase your withholding by claiming a smaller number                    spouse or a dependent, do not affect your withholding until next
of allowances, or you may enter into an agreement with your payer to have                   year, but require the filing of a new certificate by December 1,
additional amounts withheld. This is especially important if you have more                  of the year in which they occur.
than one payer, or if both husband and wife are receiving payments.
                                                                                    4. Claim additional amounts of withholding tax if desired. This will apply
2. DEPENDENTS – To qualify as your dependent, a person must (a)                     most often when you have income other than wages.
receive more than 1/2 of their support from you for the year, (b) not be
claimed  as  a  dependent  by  such  person’s  spouse,  (c)  be  a  citizen  or     5. You qualify for the low-income tax rates if your               total income from all
resident of the United States, and (d) have your home as their principle            sources are as shown below:
residence and be a member of your household for the entire year or be
related to you as follows: son, daughter, grandchild, stepson, stepdaughter,           (a)  Single                                                                               $13,447lllllllllllto lllllllllllll$16,000       
son-in-law or daughter-in-law; Your father, mother, grandparent, stepfather,           (b)  Married Filing Jointly                                                               $2 ,2676        to         $26,700
stepmother, father-in-law or mother-in-law; Your brother, sister, stepbrother,                 (1 or less dependents)
stepsister,  half- brother,  half-sister,  brother-in-law  or  sister-in-law;  Your    (c)  Married Filing Jointly                                                               $2 7,292       to    $3 , 0031
uncle, aunt, nephew or niece (but only if related by blood), or, an individual                 (2 or more dependents)
(other than your spouse) who, for the taxable year of the taxpayer, had the            (d)  Head of Household/Qualifying Widow(er) $1 ,                                            9118    to         $ , 00 233
same principal place of abode as the taxpayer and was a member of the                       (1 or less dependents)
taxpayer’s household.                                                                  (e)  Head of Household/Qualifying Widow(er)  $2 ,2790         to                                               $2 , 00 66
                                                                                            (2 or more dependents)
Once the filing status and number of allowances are established, use the 
Arkansas Withholding Tables to determine the amount of tax to withhold              For additional information consult your Plan Administrator or: 
from each distribution.                                                                        Arkansas Withholding Tax Section 
                                                                                                       P. O. Box 8055 
                                                                                                   Little Rock, Arkansas  72203-8055 
AR4P (R 1 /1 16/202 )2  

                                                           Additional Instructions 
                                                       Section references are to the Internal Revenue Code. 

Withholding From Pensions and Annuities                                             Eligible Rollover Distribution - 5% Withholding 
State income tax withholding applies to the taxable part of payments made           Distributions you receive from qualified pension or annuity plans (for example,  
from  pension,  profit-sharing,  stock  bonus,  annuity,  and  certain  deferred    401(k) pension plans, IRAs, and section 457(b) plans maintained by a govern- 
compensation  plans;  from  individual  retirement  arrangements  (IRAs);  and      mental employer) or tax-sheltered annuities that are eligible to be rolled over 
from commercial annuities. The method and rate of withholding depends on            tax free to an IRA or qualified plan are subject to a flat 5% state withholding 
(a) the kind of payment you receive, (b) whether the payments are delivered         rate. The 5% withholding rate is required, and you cannot choose not to
outside  the  United States or  its  possessions, and  (c)  whether  the recipient  have income tax withheld from eligible rollover distributions. Do not give Form 
is a nonresident alien individual, a nonresident alien beneficiary, or a foreign    AR4P to your payer unless you want an additional amount withheld. Then, 
estate. Qualified distributions from a Roth IRA are nontaxable and, therefore,      complete line 4 of Form AR4P and submit the form to your payer. 
not subject to withholding. Because your tax situation may change from year 
to year, you may want to refigure your withholding each year. You can change        The payer will not withhold state income tax if the entire distribution is trans- 
the amount to be withheld by using lines 2 and 3 of Form AR4P.                      ferred by the plan administrator in a direct rollover to a traditional IRA, qualified 
                                                                                    pension plan, governmental section 457(b) plan (if allowed by the plan), or 
Choosing Not To Have Income Tax Withheld                                            tax-sheltered annuity. 
You (or in the event of death, your beneficiary or estate) can choose not to        Distributions  that  are  (a)  required  by  law,  (b)  one  of  a  specified  series  of 
have state income tax withheld from your payments by using line 1 of Form           equal  payments,  or  (c)  qualifying  “hardship”  distributions  are  not  “eligible 
AR4P. For an estate, the election to have no income tax withheld may be made        rollover distributions” and are not subject to the mandatory 5% state income 
by the executor or personal representative of the decedent. Enter the estate’s      tax withholding. 
EIN in the area reserved for “Your social security number” on Form AR4P. You 
may not make this choice for eligible rollover distributions.                       Changing Your “No Withholding” Choice 
Periodic Payments                                                                   Periodic Payments 
Withholding from periodic payments of a pension or annuity is figured in the        If you previously chose not to have state income tax withheld and you now 
same  manner  as  withholding  from  wages.  Periodic  payments  are  made  in      want withholding, complete another Form AR4P and submit it to your payer. If 
installments at regular intervals over a period of more than 1 year. They may       you want state income tax withheld at the rate set by law (married with three 
be  paid  annually,  quarterly,  monthly,  etc. If  you  submit  an AR4P that  does allowances), write “Revoked” next to the checkbox on line 1 of the form. 
not contain your correct taxpayer identification number (TIN), the payer must 
withhold as if you are single claiming zero withholding allowances even if you      Nonperiodic Payments 
choose not to have state income tax withheld.  If you want state income tax to 
be withheld, you must designate the number of withholding allowances on line        If you previously chose not to have state income tax withheld and you now 
3 of Form AR4P and indicate your marital status by checking the appropriate         want withholding, write “Revoked” next to the checkbox on line 1 and submit 
box. Under current law, you cannot designate a specific dollar amount to be         Form AR4P to your payer. 
withheld. However, you can designate an additional amount to be withheld on 
line 5. For periodic payments, your  orm AR4P stays in effect until you change F    Statement of  Income Tax Withheld From Your Pension or An- 
or revoke it. Your payer must notify you each year of your right to choose not to   nuity 
have state income tax withheld (if permitted) or to change your choice. There 
are some kinds of periodic payments for which you cannot use Form AR4P              By January  31  of  next  year, your  payer  will  furnish  a statement to  you  on 
because they are already defined as wages subject to state income tax with-         Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit- 
holding. These payments include retirement pay for service in the U.S. Armed        Sharing Plans, IRAs, Insurance Contracts, etc., showing the total amount of 
Forces and payments from certain nonqualified deferred compensation plans           your pension or annuity payments and the total federal income tax withheld 
and deferred compensation plans of exempt organizations described in Section        during the year. 
457. Your payer should be able to tell you whether Form AR4P applies.  If you 
do not submit Form AR4P to your payer, the payer must withhold on periodic 
payments as if you are married claiming three withholding allowances.
Nonperiodic Payments - 3% Withholding 
Your payer must withhold at a flat 3% rate from nonperiodic payments (but 
see Eligible rollover distribution -  % withholding5 ) unless you choose not to 
have state income tax withheld. Distributions from an IRA  that are payable on 
demand are treated as nonperiodic payments. You can choose not to have 
state income tax withheld from a nonperiodic payment (if permitted) by submit- 
ting Form AR4P (containing your correct TIN) to your payer and checking the 
box on line 1. Generally, your choice not to have state income tax withheld 
will apply to any later payment from the same plan. You cannot use line 2 for 
nonperiodic payments. But you may use line 5 to specify an additional amount 
that you want withheld. 

AR4P Instr. (R 1 /1 16/202 )2