CLAIM FOR LOCAL TAX REBATE FORM ET-179A - formupack: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your company information in Blocks 1-6. Enter your Company Name, FEIN, Mailing Address, City, State, and Zip Code.
If you do not have an Arkansas Sales Tax Permit Number, complete Blocks 7-15 with the Owner's Name, NAICS Code of Business, Type of Ownership, Location Address, City, State, Zip Code, Contact Name, and Contact Phone Number.
In Blocks 16-19, input the Invoice Number and Invoice Date. Specify the City/County where the purchase was made and its corresponding Tax Code.
Proceed to Blocks 20-27 for Local Cap Rebate Calculations. Fill in the Invoice Amount (Block 20), Standard Cap Amount (Block 21), and calculate the Rebate Amount based on local tax rates.
Finally, sign and date the form in Blocks 28-29. Ensure all photocopies of invoices are attached before submission.

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