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Sign Here Your Signature Date Spouse s Signature Retain this form with your tax return. This form may be needed when submitting documentation to the State of Arkansas for Tax Year 2011 see instructions AR8453-OL Rev 8/23/2011 SPECIAL INFORMATION LINE INSTRUCTIONS TAX DUE Name Address and Social Security Number If you choose to file your State of Arkansas tax return by using one of the online web providers you are required to complete the AR8453-O.

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