STATE OF ARKANSAS
                  Application for Automatic Extension of Time
AR4EXT
                  to File an Annual Reconciliation for
                  State of Arkansas Withholding Taxes

FEIN: ______________________  Account ID:__________________-WHW TAX YEAR: _____    

Business Name: ______________________________________________________________

Address:          ______________________________________________________________

                  ______________________________________________________________

City, State, Zip: ______________________________________________________________

Use the Automatic Extension only for remitting the AR-3MAR Annual Reconciliation of Arkansas
Withholding taxes, state copies of form W-2, and state copies of form 1099.  The regular due date for
                  th
these forms is February 28  of the year following the tax year filed.  You may request a 30, 60, or 90 day
extension of time to file these reports.

The Automatic Extension with the Withholding Tax Branch must be filed before the due date of the
forms. Arkansas recognizes a federal extension to the federal extended due date.  You are required to
submit a copy of the Arkansas Automatic extension or the federal extension with your reconciliation
when you mail it along with your forms W-2 or 1099. THESE WILL BE KEPT ON FILE AND YOU WILL
NOT RECEIVE AN APPROVED COPY BACK.

THIS IS NOT AN EXTENSION OF TIME TO FILE WITHHOLDING PAYMENTS.

Check the box indicating the number of days needed for this extension:

                  30 days               60 days                 90 days

Signature                                                       Date

                            Mail completed extension request to:
                                        Withholding Tax Branch
                                        P. O. Box 8055
                                Little Rock,  AR 72203-8055