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                                                                                                                 PEEX222
AR1155-PET                                                                                                                                                                                                        2022

                                                                               ARKANSAS CORPORATION INCOME TAX
                                                            REQUEST FOR ARKANSAS EXTENSION OF TIME FOR
                                                                               FILING INCOME TAX RETURNS
Tax year beginning ___________________, 20______ and ending _________________, 20______.                                                                                                                          Software ID
                                                                  7D[ \HDU EHJLQQLQJ DQG HQGLQJ GDWHV DUH UHTXLUHG ÀHOGV                                                                                          DFA WEB
Name                                                                                                                                             )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU

Mailing Address  1XPEHU DQG 6WUHHW  3 2  %R[ RU 5XUDO 5RXWH 

City                                                                           State or Province                        Zip                                        Check if address is outside U.S.                                               
                                                                                                                                                 Foreign Country Name                                             

                                          FileFile onlyonly ifif youyou areare requestingrequesting aa 6060 oror 180180 dayday ArkansasArkansas extensionextension asas referencedreferenced inin ItemItem 22 belowbelow
                                                                               (See Instructions for additional information)
NAICS Code                                                                     Date of Incorporation                           Date Began Business                      Type of Corporation
                                                                                                                                                                        &KHFN RQO\ RQH ER[ 
If you are a pass-through entity and are electing the ³&KHFN WKH %R[´ provision for state income tax purposes, check the type                                           Domestic (in state)
RI HQWLW\ DQG FKHFN RQH RI WKH ¿OLQJ VWDWXV ER[HV                                                   LIMITED LIABILITY COMPANY                    PARTNERSHIP            Foreign (out of state)
1.  INDICATE TYPE OF RETURN FOR WHICH EXTENSION IS BEING REQUESTED:
                                          S CORPORATION (AR1100S) - Electing Pass-Through Entity Status - If the entity is the Parent Corporation, the Parent must request the 
                                          H[WHQVLRQ  LQFOXGH D VFKHGXOH RI 4 6XEV XQGHU WKH 3DUHQW DQG WKH 3DUHQW PXVW ¿OH WKH $UNDQVDV 5HWXUQ 
                                          Partnerships (AR1050) - Electing Pass-Through Entity Status   ,I UHTXHVWLQJ IRU  D  PHPEHU V  RI D JURXS ¿OLQJ DQ $UNDQVDV 
                                          FRQVROLGDWHG UHWXUQ  UHTXHVW H[WHQVLRQ IRU WKH SDUHQW FRUSRUDWLRQ DQG OLVW WKH VXEVLGLDULHV LQ WKH IHGHUDO JURXS HOLJLEOH WR ¿OH 
                                          LQ WKH $UNDQVDV FRQVROLGDWHG JURXS 
                                          COOPERATIVE ASSOCIATION (AR1100CT)                                     EXEMPT ORGANIZATION (AR1100CT)
2.  CHECK ONLY ONE BOX BELOW (BOX A OR %2; %  72 5(48(67 $1 $5.$16$6 (;7(16,21 
    A        Check this box if requesting an additional60 day extension from the Federal                                       Extended return due dateWR ¿OH WKH $UNDQVDV UHWXUQ 
     B       Check this box if requesting an additional 180 day extension from the Arkansas                                    original return due dateWR ¿OH WKH $UNDQVDV UHWXUQ 
3.  IF ELECTING PET STATUS USE EXTENSION FORM AR1155-PET FORM.
File this request by the original due date or, if applicable, the extended due date of the Arkansas return. A request for an extension which is postmarked AFTER the due date of
the tax return will NOT be considered.  (This also applies to an additional extension).
Please mail the Pass-through Entity Tax Extensions to the following address:                                                                    CORPORATION INCOME TAX SECTION 
APPROVED %< BBBBBBBBBBBBBBB                                                    '(1,('   ([WHQVLRQ UHTXHVW QRW ¿OHG             RQ WLPHP.O. Box 919
                                                   BBBBBBBBBBBBBBB                                                                              Little Rock, AR 72203-0919
Make check or money order payable in U.S. Dollars to “Dept. of Finance and Administration”                                                                                AR1155-PET (R 12/3/2021)
                                                                                                                 cut here
AR1155-PET                                                                                                  STATE of ARKANSAS                                           Voucher
                                                                               Pass-through Extension Tax Payment                                                       5
                                                                                                    Fiscal Year Ending BBBBBBBBBBBBBBBB12/31/2021
     Software ID                                                                                                               (MM/DD/YYYY)
                                                   DFA WEB

                                          (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU                 Due Date
                                                                                                                                                                        Mail To:
                                                                               04/15/2022                                                                          Department of Finance and Administration
                                                                                                                                                                        Pass-through Entity Tax
                                                                                                                                                                        P.O. Box 919
                                                                                                                                                                        Little Rock, AR 72203-919
     Name
     Address                                                                                                                                     Amount
                                                                                                                                                 of this           $
     City, State, Zip                                                                                                                            Payment
                                                                                                                                                                        Include Cents
     Telephone #                                                                                                                                                        (ex. 1,234,567.00)

                                                                        PETEIN0000000000012312021EXTPYM00000000000000000000000
AR1155-PET (R 4/13/2022)