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Outage Reporting: 1.800.814.2931

Sales Tax Exemption

This exemption is only for electricity customers whose income does NOT exceed $12,000 per year. Please fill in the blocks below with the information requested.

Please include your income and spouse's income for the last year.

"Income" means total income from pensions and annuities including social security, veterans' pension and disability payments, railroad retirement benefits, all public, state, and federal retirement systems; wages, salaries, and income from farm or self-employment; interest; dividends; rent and royalty income; cash public assistance and relief (SSI, etc.) income from sales of realty, stocks, and bonds; and miscellaneous income such as alimony, support money, workers' compensation, loss of time insurance, etc.

NOTE: This claim form may be audited by the Arkansas Department of Finance and Administratio

DCO-2002 (R. 11/95)-04-120020

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