The Arkansas Form Atc R4 is a state tax form that must be completed by Arkansas residents who earn income from sources within and outside of the state. The form is used to calculate the amount of income tax that must be paid to the state of Arkansas. Instructions for completing the form are included on the reverse side of the form. Residents are urged to carefully complete and submit the form on time. Penalties may apply for late submissions. Additional information about filing state taxes in Arkansas can be found on the Division of Revenue website.
| Question | Answer |
|---|---|
| Form Name | Arkansas Form Atc R4 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | arkansas alcohol server awareness form, arkansas abc server awareness form, arkansas tobacco form atc r4, arkansas server awareness |
ARKANSAS TOBACCO CONTROL
101 E. Capitol Ave., Suite 401
Little Rock, AR 72201
Phone:
Fax:
Mike Beebe |
J.R. Thomas |
Governor |
Director |
Tobacco Server Awareness Form
Each employee must initial each section, sign and date this document upon employment and before selling any tobacco products. This form is to be kept on file at the store, be accessible at all times to any clerk or employee present, and be available for inspection by any employee of Arkansas Tobacco Control.
As an employee in a permitted outlet, I understand that there are certain things I am prohibited from doing, and certain actions that I cannot knowingly allow to occur in the outlet. In accordance with Arkansas law and the Rules and Regulations of the Arkansas Tobacco Control Board, I have read and acknowledge the following:
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I will not sell cigarettes or other tobacco products to anyone under 18 years of age in accordance with A.C.A. §
I will not sell cigarettes or other tobacco products to anyone 18 years of age or older when I know the tobacco products will be provided to a person(s) under the age of 18.
I will not sell single cigarettes, or any amount of cigarettes less than a full pack (20 or 25 cigarettes packaged together constitutes a pack).
I understand that cigarettes or “other tobacco products” includes any substance that contains tobacco and/or cigarette papers including, but not limited to, cigarettes, cigars, smokeless tobacco, loose tobacco, bidis, herbal cigarettes and cigarette papers.
I understand that sales to anyone under age 18 can result in criminal charges being filed against me.
I understand that if I am found guilty of a violation of A.C.A. §
I understand that this store may undergo inspection at any time to assess its compliance with the state law regarding the sale of tobacco products to a minor under the age of 18.
By signing below, I hereby certify that I have read and fully understand the above statements. I agree to always follow state law and this store’s policies, and to not sell cigarettes or other tobacco products to minors. I further consent to allowing any current or potential employer to contact Arkansas Tobacco Control to determine if I have received any citations for violations of Title 5, Chapter 27 of the Arkansas Code.
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Employee Signature |
Date Signed |
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Printed Name of Employee |
Date Entered Employment |
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Signature of Owner, Manager or Supervisor |
Date Signed |
FORM |
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