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Get AR AR1000RC5 2017

PRINT FORM CLEAR FORM AR1000RC5 ARKANSAS INDIVIDUAL INCOME TAX CERTIFICATE FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES Primary Name Primary Social Security Number Spouse s Name Spouse s Social Security Number This certificate must be completed in its entirety to receive the 500 credit for individuals with developmental disabilities. I certify that the information listed above is true and correct. Initial Diagnosis Date Doctor or Examiner s Signature Date Street Address AR1000RC5 R 5/16/2017 .

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