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183-06 RESOLUTION
RESOLUTION NO. 183-06 A RESOLUTION GRANTING A CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY TO JC ANIMAL FARMS ENTERTAINMENT FOR THE OPERATION OF A NON - MOTORIZED TRANSPORTATION SERVICE. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: 1 ' Section 1. That the City Council of the City of Fayetteville, Arkansas hereby grants a Certificate of Public Convenience and Necessity to JC Animal Farms Entertainment for the operation of a Non -Motorized Transportation Service. • PASSED and APPROVED this 7th day of November, 2006. APPROVED: By: DAN COODY, Ma ATTEST: •• .• 'G\TYp,eC'ISG vla tU•• .�1J= :FAYETfEVILLE: ;mac.• W' 9;QkgNSP�'e J :N G .�'� ,,GroN� 10,, By: m 4 SONDRA SMITH, City Clerk • 4.1 Greg Tabor Submitted By City of Fayetteville Staff Review Form City Council Agenda Items or Contracts. 7 -Nov -06 City Council Meeting Date Division Action Required: Police Department Schedule a public hearing to determine //i `�f a Certificate of /Pubblic Convenience and Necessity should be issued to J.C. n e4,3 esti;CtCa �t of VQVevt alei Tin Seeffini wi 11 b2 sohiw fie4 Animal Farms A to F? eb dr (: o,. o Se-� - ve 44- tris ekAo N/A Cost of this request N/A Account Number N/A Project Number Budgeted Item N/A Category/Project Budget N/A Funds Used. to Date N/A Remaining Balance Budget Adjustment Attached N/A Program Category / Project Name N/A Program / Project Category Name N/A Fund Name iDepartmen 'City Attorney Previous Ordinance or Resolution # Date Original Contract Date: Original Contract Number: lD L Finance and Internal Service Director Date :Mayor Date Received [(City Cle'.'s Office Received in Mayor's Office t sefr Comments: )e7 FAYETTEVILLE THE CITY OF FAYETTEVILLE, ARKANSAS DEPARTMENTAL CORRESPONDENCE TO: Mayor Dan Coody and.Members of the City Council FROM: Greg Tabor, Interim Chief of Police DATE: October 19, 2006 RE: Request for Public Hearing on a Certificate of Public Convenience and Necessity for. J.C. Animal Farms Entertainment Recommendation: The council should schedule a public hearing to determine if a Certificate of Public Convenience and Necessity should be issued to J.C. Animal Farms Entertainment. Background: Fayetteville City Ordinance §117.81 was recently amended to authorize camels and dromedaries for passenger transport on the. Fayetteville Square. Operators of these non -motorized passenger transport services are required to obtain a Certificate of Public Convenience and Necessity prior to operation. Discussion: Attached are copies of Mr.. & Mrs. Pianalto's application, proof of liability insurance, Arkansas Certificate of Veterinary Inspection and financial statement. The Pianaltos are making the request to permit theuse of up to 2 camels for rides on the Fayetteville Square during the "Lights of the Ozarks". Their certificate of insurance lists event dates of November 11`h through December 31st, 2006. • RESOLUTION NO. A RESOLUTION GRANTING A CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY TO JC ANIMAL FARMS ENTERTAINMENT FOR THE OPERATION OF A NON - MOTORIZED TRANSPORTATION SERVICE. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayettevil _Anka) s hereby grants a Certificate of Public Convenience and NecessityQ,os4C Animal Farms Entertainment for the operation of a None `Tra p:rtation Service. H PASSED and APPROVED this 7th da ' pf November,06. PPRO\ Y JL B: Y. SOS DILA SMITH, City Clerk • 'AV COODY, Mayor • OCT -18-2006 03:35PM FROM-FAYETTVILLE POLICE 4T9 587 3522 7-679 P.002/004 F-853 • JC Justin Certificate of Public Convenience & Necessity Application/Renewal As required to comply with Chapter 117 of tho Fayetteville Code of Ordinances and Casey Pianalto/ 1565 Eldridge Rd, Springdale AR 72762 (479)530-9119 Applicant Farms Name Address Phone Animal Entertainment (479) 530-9119 Number Name 1565 of Eldridge Business Phone Rd, Springdale AR 72762 Number Business 1565 Eldridge Location Rd, Springdale AR 72762 Mailing DBA Address Type of Name end Justin Business address Pianalto (Sole of Proprietor, Corporation, all owners, officers and 1565 Eldridge stockholders: Rd, LLC) Springdale AR 72762 Casey Pianalto 1565 Eldridge Rd, Springdale AR 72762 Name of person to Casey Pianalto whom complaints should (479) 530-9119 be directed: Financial status of applicant (Attach financial statement or profit and loss statement) • PI OCT -18-2006 03:35PL1 FROM-FAYETTVILLE POLICE • 478 587 3522 1-678 P.003/004 F-853 List any unpaid Judgments against any of the owners, officers and stockholders and tho nature or acts giving rise to Bald Judgments: NA Describe the experience of all owners, officers and stockholders In the transportation of passengers; We have been working with animals for over 15 years. My family have owed the camels for 9 years, and been doing Christmas plays for 5 years. We have been doing camel rides over the past year. • Give any facts you believe tend to prove the necessity of granting a ce• rtificate: List the number of vehicles that will be under your operation or control; 2 Minimum and Maximum number of vehicles to be permitted: List the location of proposed depots and terminals: 1 Minimum 2 Maximum We are planning to work on the South side of the Fayetteville quare during the Lights of the Ozarks 2006. We have been working with Sharon Crosson on this location. a • OCT -18-2006 O3:35PM FROM-FAYETTVILLE POLICE • 478 587 3522 T-670 P.004/004 F-853 2 Describe the cofor scheme or insignia to be used to designate your vehicle: The camels are tan and will havered saddels and black,red or preen blankets on. The loading plat form that will be used is red and our barricades to block off our location are yellow. Thereameis agesear.ei202.and2i8 years old. List your days and hours of operation: "Wheather permitting" we plan to work every night from the hours of 6p.m. till 12a.m. We may close earlier if there is no business. List any days you do not propose to provide taxicab service to the general public: We will not provide the camel rides during rain or bad weather. List your proposed passenger rate schedule: The camel rides will be $5.00 per rider and additional for pictures. Pollee Department Representative Date AUG -22-2006)1E 09:38 AM FAX NO. 407 645 2810 P. 02 CERTIFICATE OF INSURANCE PRODUCER: I.ESI'ER KALMANSON AGENCY, INC. P.O. BOX 940008 MAITLAND, FL 32794-0008 PH: (407) 645.5000 FAX: (407) 645-2810 DATE ISSUED: 08/21/2006 COMPANY: 100% CERTAIN UNDERWRITERS AT LLOYD'S / LONDON POLICY NUMBER: NCM255 NAMED INSURED: EFFECTIVE DATE: EXPIRATION DATE: BUNKY BOGER ET AL 03/28/2006 03/28/2007 13231 HICKORY CREEK ROAD LOWELL, AR 72745 (BOTH DAYS AT 12:01 AM LOCAL STANDARD TIME) COVERAGE INFORMATION THIS IS TO CERTIFY THAT THE POLICY(S) OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM(S) OR CONDITION(S) OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 1 HIS CERTIFICATES) MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SURIFCT TO ALL THE TERMS, EXCLUSIONS AND/OR CONDITIuNS OF SUCH POLICIES.L1MITS OF LIABILITY SHOWN MAY HAVE BEEN REDUCED BY ANY PAID CLAIMS TYPE OF INSURANCE: LIMITS: X GENERAL LIABILITY GENERAL AGGREGATE: 41,000,000,00 ,X.CLAIMS MADE LIMITED PRODUCTS AGGREGATE 5-0- X OWNERS, LANDLORDS, & TENANTS PERSONAL & ADV. INJURY: 4 -0 - EACH OCCURRENCE: $ 1,000,000.00 RETRO DATE: 03/28/2004 FIRE DAMAGE (ANY ONE FIRE) S -0 - ADDITIONAL INSURED(S); FAYETTEVILLE ARKANSAS SQUARE IS/ARE HEREBY ADDED AS ADDITIONAL INSURED ONLY AS THEIR INTEREST MAY APPEAR IN RESPECTS TO THE OPERATION(S) PERFORMED BY THE NAMED INSURED AND/OR IT'S EMPLOYEE(S) ONLY. SEE ATTACHED ADDENDUM "A" FOR DESCRIPTION OF LIABILITY COVERAGE(S) AFFORDED. EVENT DATE(S): NOVEMBER 11, 2006 THROUGH DECEMBER 31, 2006 LOCATION: FAYETTEVILLE ARKANSAS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 111E CERTIFICATE HOLDER.THTS CERTIFICATE DOES NOT AMEND, EXTEND OR ATTER THE COVERAGE(S) AFFORDED BY THE POLICY(S) LISTED. "LIMITS SHOWN ARE THOSE IN EFFECT AS OF POLICY INCEPTION" SHOULD ANY OF THE ABOVE DESCRIBED POLICY(S) BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 00 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION(S) 14./OR LIABILITY(S) OF ANY KIND UPON THE COMPANY, IT S AGENTS &/OR REPRESEN'TA'TIVES &/OR KALMANSON ET AL CERTIFICATE HOLDER / ADDITIONAL INSURED: AIJ'I'IIORIZEDREPRESENTATIVE: FAYETTEVILLE ARKANSAS SQUARE FAYETTEVILLE, ARKANSAS FAX# 479/527.2568 x ,1 j MITCH AL ON / PRESIDENT Original to Accompany Shipment, 1st and 2nd Copy to Office of State Veterinarian 1. 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Use the IRS label. Otherwise, please print or type. 1 2 3 Federal income tax withheld (Form 1040, line 64; Form 1040A, line 39; Form 1040EZ, line 7) 4 Refund (Form 1040, line 73a; Form 1040A,)ine 45a,Fodn 1040EZ ne 5 Amount you owe (Form 1040, line 75,form10400line47;Perm 104OEZ,line12) ,.; •_ . 482. Declaration of Taxpayer fi.gn only after Part 1r rs completed) Ba4uret*)keep a copy of your tax return. 6a 1 1 consent that my refund be.alfectlydeposltep..asde.5+gnated In theelecte)etepodien of my2005 Federal income tax return. If l have filed a joint return, this is an irrevocable:appointment of tne.otberspouse as adagenitoteceivethe;r9fund ,. .. b Itil I do not want direct deposit of my refund or l am not receiving a refund. c I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal entry to the financial institution account indicated in the tax preparation software for payment of my Federal taxes owed on this return and/or a payment of estimated tax. I further understand that this authorization may apply to subsequent Federal tax payments that I direct to be debited through the Electronic Federal Tax Payment System (EFTPS). In order for me to initiate subsequent payments, I request that the IRS send me a personal identification number (PIN) to access EFTPS. This authorization is to remain in full force and effect until l notify the U S Treasury Financial Agent to terminate the authorization. To revoke a payment, I must contact the U S Treasury Financial Agent at 1-888.353- 4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. If I have filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability, I will remain liable for the tax liability and all applicable interest and penalties. III have filed ajoint Federal and state tax return and there is an error on my state return, I understand my Federal return will be rejected. L A B E L H E R E You first name and initial JUSTIN C Last name PIANALTO �r. If a joint return,spouse's first name and initial CASEY L Last name PIANALTO Home address (number and street). If you have a P.O. box, see instruction' 1565 ELDRIDGE RD City, town or post office, state, and ZIP code SPRINGDALE, AR 72762 . Tax Return Information (Whole dollars only) Adjus ed gross income (Form 1040, line 38; Form 1040A, line 22; Form 1040EZ, line 4) Total tax (Form 1040, line 63; Form 1040A, line 38; Form 1040EZ, line 10) cLa 1 2 3 74,947. 8,049. 7,567. 4 5 Under penalties of perjury, I declare that I have examined aeopy:oHnyetectronie.lndlwdual income:tax return and accompanying schedules and statements for the tax year ending December 31, 2005, aed to the best ©f:thy knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts shown on diecopy 01.my eleetroriie income takreturn;i.consent to allow my electronic return originator (ERO) to send my return to the IRS and to receive from the IRS Wan acknowledgment of recelptpwTeason for re ection of the transmission, (b) an indication of any refund offset, (c) the reason for any delay in proces9kftg the return: trefund, and (d)*% date ofany re und. Sign ' COPY ONLY 1 COPY ONLY Here Your signature Date Spouse's signature. If a joint return, both must sign. Date !Parte)II. Declaration of Electronic Return Originator (ERO) and Paid Preparer (See instructions.) I declare that I have reviewed the above taxpayer's return and that the entries on Form 8453 are complete and correct to the best of my knowledge. If lam only a collector, l am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will have signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with the IRS, and have followed all other requirements in Pub. 1345, Handbook for Authorized IRS e- file P oviders of Individual Income Tax Returns. I1 1 am also the Paid Preparer, under penalties of perjury I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This Paid Preparer declaration is based on all information of which I have any knowledge. ERO's Use Only Date Check if ERO's Oj also paid � signature 03/14/2006 preparer I^I name(or yoursitself-employed), 'H AND R BLOCK EASTERN ENTERPRISES I yours address, and ZIP code FAYETTEVILLE, AR 72703 Phone no. (479) 521-1753 Under penalties of perjury, I declare that I have examined the above taxpayer's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. This declaration is based an all information of which I have any knowledge. Check if self n employed I I ERO's SSN or PTIN EIN 43-1862224 Paid Preparer's signature Preparer's Firm's name (or Use ODI yours if self- employed). y address, and ZIP code Date Check if self employed P1 Preparer's SSN or PTI N EIN Phone no. KBA For Paperwork Reduction Act Notice, see separate Instructions. Form 8453 (2005) 8453 (2005) F084530- 1V 1.91 Form Software Copyright 1996 - 2005 H &R a lock Tax Services. Inc. Form 1040 Department al the Treasury - Internal Revenue Service U.S. Individual Income Tax Return 0 05 (99) IRS Use On! Do not write or staple in this space. Label Use the IRS label. Otherwise, please print or type. Presidential Election Campaign For the year Jan. 1- Dec. 31. 2005. or other tax year beginning 2005. ending .20 OMB No. 1545- 0074 JUSTIN C PIANALTO CASEY L PIANALTO 1565 ELDRIDGE RD SPRINGDALE, AR 72762 Filing Status Check only one box. 1 2 3 Your social security number 429-69-8352 Spouse's social security number 429-59-5762t/ • Yom SMSNlgs) above. A Checking a box below will not change your tax or refund. ► Check here it you, or your spouse if filing jointly, want $3 to go to this fund (see page 16) to You I—I Spouse Single 4 I I Head of household (with qualifying person). (See page 17.) Married filing jointly (even,itiont ionehad;incottte)_. .. •. • atine ouautyrhg person is a child but not your dependent. enter this Married ti ling separately. Eater spousesSSnabove & tEallame;NClow. %:; child'slriarhe here. Ow ► --- ._„ 5 n Qualifying widow(er) with dependent Exemptions If more than four dependents, seepage 19 6a b c X X Yourself. I1 someonenan claim you;as a dependen do not check boxisa Spouse .. .....: child (see page 17) Boxes checked on 6a and 6b No. of children Dependents: (1) First name Last name (2) Dependent's social security number (3) Dependent's relationship to you on fic who: Ail dual, r,lived with you child to :hild la r. •did not live with you due to divorce or separation Dependents an 6c not entered above 2 Income Attach Form(s) W- 2 here. Also attach Forms W- 2G and 1099- R if tax was withheld. If you did not geta W-2, see page 22. Enclose, but do not attach, any payment. Also, please use Form 1040- V. Adjusted Gross Income d Total number of exemptionsclaimed 7 Wages, salaries, tips,etc:Rttacn Form(sbW:•_ 2- --- 8a Taxable interest.Attach'Schedulea if'required Add numbers on lines above ► b Tax-exempt interest. Donotlnciude online 8a ---- HID 9a Ordinary dividends. Attach Schedule B if required b Qualified dividends (see page 23) 7 75,599. 8a 98. 19b I 10 Taxable refunds, credits, or offsets of state and local income taxes (see page 23) 11 Alimony received 12 Business income or (loss). Attach Schedule C or C- EZ 13 Capital gain/(loss). Attach Sch D. a not required check here ► �, 14 Other gains or (bssesL.Attach Foam 4797 . 15a IRA distributions 15a o Taxan eamt 16a Pensions and annJ ties 16a o Taxan a amt 17 Rental real estate, royal des ;,partnerships; S corporattons,tldsts, etc;; Attach Sched018E 18 Farm income.ot::Uoss}. Attacn Schedule F 19 Unemployment compensation 20a Social security benefits . _ 120aI I b Taxable amt 21 Other income. List type and amount (see page 29) CHURCH PAGEANT INCOME KATHY BO 1c250. 22 Add the amounts in the lar right column for lines 7 through 21. This is 23 Educator expenses (see page 29) 24 Certain business expenses of reservists; -performing artists. and fee- basis government officials 7ltfach Form 2.06 oeR106 EZ 25 Health savings accountdeducfen_attach Form -8889. 26 Moving expenses. Attach Form -3903 27 One- half of self- employmen4'.l&i<. Attach Schedule•S .... 28 Self- employed SEP, SIMPLE, and qualified plans , 29 Self- employed health insurance deduction (see page 30) 30 Penalty on early withdrawal of savings 31a Alimony paid b Recipient's SSN ► 32 IRAdeduction (see page 31) 33 Student loan interest deduction (see page 33) 34 Tuition and fees deduction (see page 34) 35 Domestic production activities deduction. Attach Form 8903 36 Add lines 23 through 3la and 32 through 35 37 our total income _ , ► 9a 10 11 12 13 14 15b 16b 17 18 19 20b 21 1,250. 22 76,947. 23 24 S1 26 27 28 29 30 31a 32 2,000. 33 34 35 Subtract line 36 from line 22. This is your adjusted gross income 36 37 KBA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78. 1040(2005) FD1040- 1V 1.25 5 H Form oftware Copyright 1996 - 2005 SR Block Tax Services. Inc. 2,000. 74,947. Form 1040 (2005) Form1040(2005) JUSTIN C & CASEY L PIANALTO Tax and Credits Standard Deduction for - • People who checked any box on line 39a or 39b or who can be claimed as a dependent, see page 36. • All others: Single or M arried f iling separately. $5.000 M arried l iling jointly or Qualifying widow ler). $10.000 Head of household. $7.300 38 Amount from line 37 (adjusted gross income) 429-69-8352 Paget 38 39a Check You were born before January 2, 1941, _ Blind. Total boxes 11: Spouse was born before January 2, 1941, Blind. } checked ► 39a b Il your spouse itemizes on a separate return or you were a dual- status alien. see pg 358 check here ► 39b 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 Itemized deductions (from Schedule A) or your standard deduction (see lett margin) , Subtract line 401rom line 38 - v If line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina , see page 37. Otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d , Taxable income. Subtract line 42 from line 41.1f line 42 is more than line 41, enter - 0- Tax . Check ifany tax isfrom: an Form(s)8814 b Form 4972 Alternative minimum tax {scidpage 39)..ABaC[i:Form 62$1- __ Add lines 44 and 45 tt Foreign tax cred it. Attachform 11161trequired ; - 47 Credit for child and depetidentcamexpenses Attath:f0rm 2441 Credit for the elderly or the giSabled. Atfadhached uldlit. Education credits. Attach Form 8863 Retirement savings contributions credit. Attach Form 8880 Child tax credit (see page 41). Attach Form 8901 if required Adoption credit. Attach Form 8839 Credits from: a Form 8396 b ( I Form 8859 , Other credits. Checkapplicablebox(es): a n Form 3800 b n Form8801 c nForttY Add lines 47 through 55. Theieare your dtai cretin -9 57 Subtract line 56 from line:46. 0 fine 56.is MOM than Gate 46 enter -0- ► j 40 74,947 10,000. 41 64,947. 42 6,400. 43 58,547. 44 8,049 45 ► 46 48 49 50 51 52 53 54 55 // 56 8,049 57 8,049 Other Taxes Payments Ifyou have a 1 - qualifying child, attach Schedule EIC. 58 Sell- employment tax. Attach Schedule SE. 59 Social security and Medicaretax On tip incomenotreportedxosemployer:Attach Form 4137. 60 Additional lax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 61 Advance earned income credit payments from Form(s) W-2 62 Household employment taxes. Attach Schedule H 58 59 60 61 62 �/� 63 Add lines 57 through 62. This is your total tax ► 63 64 Federal income tax withheld from Forms W -land 1099 65 2005 estimated:tax-payments &ameentapplied from2004 return 66a Earned income credit (EIC) b Nontaxablectmbat pa/ electron ► 66b 67 Excess socialsecurityand tier;1 RRTA:tax wnh nerd see page'59) 68 Additional child,taxcred it. Attachform 8812 . , • .. 69 Amount paid with request for extension to file (see page 59) . , 70 Payments from: a 11 Form 2439 b n Form 4136 C nForm 8885 71 Add Ins 64.65.66a.&67 through 70. These are your total payments 64 85_ 7,567 66a 67 68 69 70 ► 71 8,049 7,567 Refund Direct deposit? See page 59 and fill in 73b, 73c, and 73d. 72 If line 71 is more than line 63, subtract line 63 from line 71. This is theamoun you overpaid , 72 73a Amount of line 72 you want refunded to you ► 73a ► b Routing number ► c Type: Checking I Savings ► d Accountnumber---- 74 Amount of line 72 you want applied to your 2006estimated tax fr I74I Amount You Owe Third Party Designee Sign Here Joint return? See page 17. Keep a copy for your records. Paid Preparer's Use Only 75 Amount you owe. Subtract line711fmrn-line 88l1 or:detai s on hOwtopay see page 60 . 76 Estimated tax penalty (see pag@60) Do you want to allow another person todiscuss thisreturn wgwAheiASeea:page .6 )? (XI Yes. Complete the following. Designee's name Phone no Personal ID number ► HR BLOCK j l� ► 75 482. No ► (479) 464-7515 (PIN)► 03135 Under penalties of perjury. I declare that I have examined this relu n and accompanying chedules and statements. and to the best of my knowledge and belief. they are true. correct. and complete. Declaration of preparer (other than taxpayer is based on all information or which preparer has any knowledge. Your signature Date For Info Only -Do not file Spouse's signature. If a joint return, both must sign. For Info Only -Do not file Preparers signature Firm's name (or H AND R BLOCK EAST Date yours i1 sell-employed),' address, and ZIP code FAYETTEVILLE, AR 7 Your occupation MANAGER Daytime phone number Spouse's occupation LOAN PROCESSOR Date 3/ 14/2006 Preparers SS N or PTIN Xed Phoneno.(479 52 P00138238 IIEIN 43-1862224 Check if self-emplo n ERN ENTERPRISES 1040 (2005) FD1040- 2V 1.25 Form Software Copyright 1996 - 2005 H&R e lock Tax Services. Inc. 2703 ) 1-1753 Form 1040(2005) HRH • AR8453 0 0 7 1 0 1 0 8 6 Arkansas Individual Income Tax Declaration for Electronic Filing For the tax year January 1 - December 31, 2005 2005 USE STATE LABEL OR PRINT First Name and Initial JUSTIN C CASEY L Last Name(s) PIANALTO PIANALTO Your SocialSecurity4 • 429-69-8352 Present Address 1565 ELDRIDGE RD ;• Spouse's Social Secury ft 429-59-5762 City, Town SPRINGDALE or Post 011ice Box, Stateand Zip Code AR 72762 Telephone Number (479) 530-9119 PART 1 TAX RETURN INFORMATION (Whole: Dollars Only) 1. Total Income (Form AR1000orAR1000NR,Line 2, Net Tax (Form AR1000 orAR1000NR, Line 44) 3. State Income Tax Withheld (Form AR1000 orAR1000NR, 4. Refund (Form AR1000orAR1000NR,Line 501 5. Tax Due (Form AR1000 or AR1000NR, Line'.641. 23) _ Line 45) ............... ......-....._ ._.... ......... .,, 1 76,947 00 2 3,232 00 3 3,621 00 4 389 00 5 00 PART 2 DECLARATION OF TAXPAYER .. 6a. I consent that my refund be directly deposited as designated in the electronic portion of my 2005 Arkansas income tax return. If I have filed a ioint return, this is an irrevocable appointment of he other spouse as an agent to receive the refund. b. © I do not want direct deposit of my refund or l am not receiving a refund. If t have Tiled a balance due return. I understand that it the State of Arkansas does not receive lull and timely payment of my tax liability. I will remain liable for the tax liability and all applicable interest and penalties. If I have filed ajoint Federal and state tax return and my federal return is rejected. I understand that my state r eturnw ill be rejected also. Under the penalties of perjury. 1 declare that the inf ormation I have given my ERO and the amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 2005 Arkansas incomes ax,ett#n:zTo the Dest olmonnow ledge ang:tlelrel. my:Teturai§ltue correctiand'cRtbpgete. I consent to my ERO sending my return. this declaration. and accompanying se F,leautes art : taterttents to thie:State of Arkapsaa; I alsoconsBiitlo the SEift'e oI Ait.nsas sending my ERO ar,dlor transmitter an acknowledgement of receipt of transmission aog an Intl geUeRpl whether Ar not my retumvls ap`tepted', andjt rejected jjbe re46n(s1f or the rejection. If the processing of my return or refund is delayed. I authorize the Sfete oI Arkarlsasto Ursclose trrlity ERO andtde tratiMibittei theieason(s)Iotthe data. 0r when the refund was sent. Sign COPY ONLY Here Your Signature Date COPY ONLY Spouse's Signature Date PART 3 DECLARATION OF ELECTRONIC RETURN ORIGINATOR (ERO) AND PAID PREPARER I declare that I have reviewed the above la payers ret rn and that the entries on Form AR8453 a e complete and correct to the best o1 my knowledge. If I am only a collector. I understand that I am not responsible for reviewing the taxpayer's return: I declare that Form AR8453 accurately ref Iects the data on the return. I have obtained the taxpayers signature on Form AR8453 bet ore submitting this return to the State of Arkansas. and have provided the taxpayer with a copy of all I orms and int ormation to be 1 iled with the State of Arkansas.11 I am also the Paid Prepare:. under penalties of perjury I declare that I have examined the above taxpayers return and accompanying schedules and statements. and to the best of my knowledge and belief. they are true. correct Star. ,itipitite TliididectaPiation of PaNiPi'kp¢tPiii§'based an an int ormation al which the prepare, has knowledge. Chess: Check 03/14/06 Cf X Isef- • ERO's ERO•s Signature Dale prepare:' employed Your SSN or PTIN Use H AND R BLOC 3015 N COLLEGE FAYETTEVILLE AR 72703 43-1862224 Only Firm's name and address FEIN Under penalties of perjury. I declare that I have examined the above taxpayer's return and accompanying schedules and statements. and to the best of my knowledge and belie) they are true. correct and complete. This declaration is based on all inf ermation of which I have any knowledge. Check❑ Paid if self- Preparer's Preparer's Signature Date employed Preparer's SSN or PTIN Use Only Firm's name and address FEIN AR8453(R11/05) DO NOT MAIL THIS FORM 84530 (2005) AR8453D- 1V 1.31 Form Sof tw are Copyright 1996 - 2005 H8R Block Tax Services. Inc. HRB 2005 AR1000 Full ARKAS ANSYear IND 1ID TL INCOME TAX RETURN D pt. Use Only FOR INFORMATION ONLY Jan1 Dec 31, 2005 or fiscal year ending ,20 • • • F U ER ER L I T A NY P Eo8°1565 OR RIIllportant FIRST NAME(S) AND INITIAL(S) (List both it applicable) JUSTIN C CASEY L LAST NAME(S) (See Instructions) PIANALTO •PIANALTO YOUR SOCIAL SECURITY NUMBER • 429-69-8352 MAILING ADDRESS (Number and Street, P.O. Box or Rural Route) ELDRIDGE RD SPOUSE'S SOCIALSECURITY NUMBER • 429-59-5762 CITY, STATE AND ZIP CODE •SPRINGDALE, AR 72762' ..::: :_= You MUST: • enteryolir A SSN(s)above?' H I S E L AD NUN GSo N E 1.•_ 2. • SINGLE(or widowed before 200539r divorced:atend MARRIED FILING JOINT(EventillOnly onetladtiritome) ' rilARRIEDIFILING SEPARATELY ON THE SAME RETURN Si+_ -. MARRIED:FILING SEPARATELY ON DIFFERENT RETURNS Enterspouse's name here and SSN above 3. • HEAD OF HOUSEHOLD (See Instruoti.Ons) ..,... If the qualifying person is your child, but not your dependent, enter child's name here: 6.•� QUALIFYING WIDOW(ER) with dependent child. Year spouse died: (See Instructions) HAVEYOU ILEDA'FEDERAL'EXTENSION9 _ •I 1 Check this box if you have filed an automatic Federal Extension Form 4868. (See Instr.) Pr, E 13 E S D N T A L S 7A. X YOURSELF •_ 65 or OVER •D 65 SPECIAL • BLIND • DEAF I I HEAD OF HOUSEHOLD/ 42 X SPOUSE • 65 or OVER •„ 65:SP,ECIAL i• BLIND"1: DEAF QUALIFYING WIDOW(EFO _ Multiply number:pt boxescbeckedilrom Line 7A 2 X $21 = 7B. First name(s) of dependent(s): (Do nWaist yoursefiorspouse)i:'MUltipty.number of dependents ..from Line.78 _... • X $21 = 7C. First name of developmentallydisabled individual(s): (See Instr.) Multiply number of developmentally disabled individuals from Line 7C ' • X $500 = 7D. TOTAL PERSONAL CREDITS: (Add Lines 7A, 7B and 7C. Enter total here and on Line 36) 7D 42 Q T A C A H T T C AH C E H K ZC I N C1 P 0 0 9 M9F E ow R2 Is)/ 1 E 9 FEL 9 E G m IS) ROUND ALL AMOUNTS TO WHOLE DOLLARS 8. Wages, salaries tips, etc.:: , , - .. , 8 (A) Your/Total Income (B) Spouse's Income Status 4Only -- ----37-1246 8 1 9B 108 11 12 13 14 15 16 17 18 19B 20 21 22 23 381353 - (yo,.u1otxt 9A. us. Military Of l icer's campentotion gross arms • _ - - les• stoop 9A ---- �" '6pouces 98. U.S. Military Of ricers cempensalo rO$Saft) - - • ._... - "'-less ..$6,000 ._...: :. ft-Ob/010mi 10A. U.S. Military Enlisted compehsa' on pion !AM - • ..... : LAM f•.d001OA .. $' SPOySe3 IOB. U.S. Military Enlisted compensation g•oss alit) • . -eS5 19.000 ..::'. 11. Minister's inc. Gross $ Les rental value $ 11 12. Interest income: (If over $1,500, attach page AR4) 12 13. Dividend income: (li over $1,500, attach page AR4) 13 14. Alimony and separate maintenance received: 14 15. Business or professional income: (Attach Federal Schedule C or C- EZ) 15 16. Capital gains/losses from stocks,bonds,etc.: (See Instr. Attach Federal Sch D) 16 17. Other gains or (losses): (Attach Federal Form4797)- -,-, ;17: : 18. Non- Qualified IRA distributions and taxableehnuities: '- .18 19A. Your/Joint Employer pension plan (s)/Qual}fled IRA(s): (se-tmpenahLine lsuurriiEiTatls9 84 14 • • Gross Distrib • Taxabl6Amt • ;^--14600019A 198. Spouse's Employer pension plan(s)/Quallted IRAs) (FII61g Staltts:4 Only) ..', Gloss Disblb • Taxable Amt Less 56.000 19B 20. Rents,royalties,partnerships, estates, trusts, etc: (Attach Federal Schedule E) 20 21. Farm Income: (Attach Federal Schedule F) 21 22 Other income: (List type and amount. See Instr.) CHURCH. RAGE 22 1 , 250 23. TOTAL INCOME: (Add Lines 8 through 22) 23 • 37/330 • 391617 oM J n s T s T 24. Border city exemption: (Attach Form AR- TX) 24 25. Total Other Adjustments: (Attach Form AR1000ADJ) 25 26. TOTAL ADJUSTMENTS: (Add Lines 24 and 25) 26 27. ADJUSTED GROSS INCOME: (Subtract Line 26 from Line 23) 27 • 24 25 26 27 • 1,000 1,000 • 1 , 000 • 1,000 • 361330 • 38/617 Page ARI (R 11/05) 1000 (2005) AR 1000- 1V 1.61 Form Sol l ware Copyright 1996 - 2005 H&R Block Tax Services. Inc. HRB JUSTIN C & CASEY L PIANALTO - Page AR2 (R 11105) 10001(2005) AR 1000- 2V 1.61 Form of lware Copyright 1996- 2005 H8R Block Tax Services. Inc. T A X C O M p U T T30. 1 0 N (A) Your/Total Income (B) Spouse Income Status4Only 28. ADJUSTEDGROSS INCOME: (From Line 27, Columns A and B, Page AR1) 28 36,33028 38,617 29. Select tax table: (Check the appropriate box) 3,058 •❑ LOW INCOME Table 1 X REGULAR Tablet _ If you qualify for the Low Income Tax Table, enter zero (0) on Line 29A. If not, then: Enter • X Itemized Deductions (See Itemized Deduction Instructions, Line 28) 1 the larger? OR of your: J Standard Deduction (See Standard Deduction Instructions) 29 • 2 822 29 • , NET TAXABLE INCOME: (Subtract Line 29 from Line 28) 30 • 33,50830• 35,559 31. Tax: (Enter tax from tax table) 31 1 , 567 31 1 , 707 32. Combined tax: (Add amounts from Lines3 A8nd 31B) 33. Enter tax from Lump Sum Distribution Averaging:Stnedule: (Atl_aCh A81000TD)- -; - . 34. IRA and qualified plan withdrawal andelOverpayment lenalties: AttatAFeder$IForm 5;329, 35. TOTAL TAX: (Add Lines 32 through 341 . . . ... -_ _, if required) 32 33• 34• 35 • 3, 274 3,274 T A X C R E D I T S 36. Personal Tax Credit(s): (Enter total from:One1D, pageAR1} -- 36::• 42 37. State Political Contributions Credit: (Attach AR1800 or schedule) 37• 38. Other State Tax credit: [Attach copy of other state tax return(s)] 38• 39. Child Care Credit: 120% of Federal credit allowed: Attach Federal Form 2441 or 1040A. Sch. 2) 39 40. Credit for Adoption Expenses: (Attach Form 8839) • 40 • 41. Phenylketonuria Disorder Credit: (See Instructions. Attach AR1113) 41 • 42. Business and Incentive Tax Credit(s): (Attach schedule and certificate) 42 • 43. TOTAL CREDITS: (Add Lines 36through-42)' - , __,_ , _ _ _ _ _ _ _ _ 43 • 42 44- NET TAX: (Subtract Line 43 from Line 3fi,: If Line 43:ts greater ina itis 35 enter 04::.;:;.44 • 3 2 3 2 , P A y M E N T 5 45. Arkansas income tax withheld [AttactiState copies:olW-2FOrm(sf 45•,� 3,621 46. Estimated tax paid or credit brought foWardfropI tyear:.-.:,.-' ,.'. 46<• 47. Payment made with extension: (SeeInstrucbot%) ._.. . .. :.:. :43:• 48. Early childhood program: Certification Number: C20% of Fed. credit allowed; Attach Fed. Form 2441 or 1040A. Sch. 28 Form AR1000EC) 48 • 49. TOTAL PAYMENTS: (Add Lines45through 48) 49 • 3 , 621 I ao 0zcmm171 MCO XD -1 50. AMOUNT OF OVERPAYMENT/REFUND: (If Line49 is greater than Line 44, enter difference) 50 • 389 51. Amount to be applied to 2006 estimated tax: 51 • 52. Amount of Check- of1 Contributions: (Attach Schedule AR1000- CO) 52• 53. AMOUNT TO BE REFUNDEDTQYOU: (Su buactt nes 51 and 521rom Line -50) _... '-- "':AEFUND 53.0 389 54. AMOUNT DUE: (If Line 49 isIeSstnan.:Llne44; ente-difference; If over:$1,O00See InstructIonsl . TAX DUE 54 • L/J\ 55A. Attach Fm AR22108 enter exception it ::bpx: 55A • )_Penalty 558 55C. Please attach your check onmoney ocder;payaoieto:£Dept. of FnanceandAdmtnlstration".:rlor the -fax due . and penalty (if applicable):,Besureto write your -Social Security;Numoeron.your check..:. - ,L,;.;; TOTAL DUE 55C • 56. Amount of income not subject to Arkansas tax from AR4, Part Ill: (Memorandum only) May the Arkansas Revenue Agencyd•scuss this return with the preparer XYes shown below? No 5 P I LG EN AH sE ER E PLEASE SIGN HERE: Under penalties of perjury, l declare that l have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct and complete. Declaration of preparer (other than taxpaye ) is based on all information of which preparer has any knowledge. Your Signature - FOR INFORMATION ONLY Occupation -- - -•Date MANAGER Home Telephone: 479-530-9119 Spouses Signature FOR INFORMATION ONLYL0AN Occupabonti6te PROCES Work Telephone: 479-530-0710 p PER A P 1A E R Paid Preparer's Signature • IDNumpeaSo'al$ecurity'*imber •43-1862224 For Department Use Only Preparer's Name City/State/Zip A • H AND R BLOCK EASTERN ENTERPR FAYETTEVIL AR 72703' B. Address Telephone Number C • 3015 N COLLEGE AVE (479) 521-1753 D• Please Note: DUE DATE IS APRIL 17, 2006 F� 7-,� Mailing.;; In}Ofmatl011 . .: : Mail REFUNDretums to: DFA State Income Tax, P.O. Box 1000, Little Rock, AR 72203-1000. Mail TAX DUE returns to: DFA State Income Tax,. P.O. Box 2144, Little Rock, AR 72203-2144. Mail NO TAX DUE returns to: DFA State Income Tax, P.O. Box 8026, Little Rock, AR 72203-8026. Page AR2 (R 11105) 10001(2005) AR 1000- 2V 1.61 Form of lware Copyright 1996- 2005 H8R Block Tax Services. Inc. HRB AR1000ADJ STATE OF ARKANSAS SCHEDULE OF OTHER ADJUSTMENTS INDIVIDUAL INCOME TAX RETURN ATTACH AS THE SECOND PAGE OF YOUR RETURN 2005 Name •JUSTIN C & CASEY L PIANALTO Social Security Number .429-69-8352 INSTRUCTIONS AR 1000 Full Year Resident Filers - Completecglumn (A)only1:ltusing filing:status 1(sin9)01,1ipngst2fus2 (married filing joint), filing status 3 (head of household),filing status 5 (married. Tiling separately on dIlerent:ftatutns)forf(ling:sla is 6 (qualifying widow or widower). Complete columns (A), and (B) only, if using filing::status 4,(mare60:111ing sep2rate(y on the same return). AR 1000NR Nonresident or Part Year Resident Filers - Complete column (A) and (C)only, if using filing status 1 (single), tiling status 2 (married filing joint), filing status 3 (head of household), filing status 5 (married filing separately on different returns) or filing status 6 (qualifying widow or widower). Complete columns (A), (6), and (C), only if using filing status 4 (married filing separately on the same return). Total each column, ii required, and enter the total on Line 14 of this form and on Line 25 of page AR1) NR1 of Form AR 1000/AR 1000NR. See line by line instructions on page 2 of this 'form.• AR1000A0J (R 11105) 100012005) AR 1000- 3V 1.61 Form Soltware Copyright 1996 - 20051-18R Block Tax Services. Inc. 1. 2. 3. 4. 6. 7. 8. 9. 10. 11 12. 13. 14. Payments to IRA: (See Instructions) Payments to MSA: (See Instructions) Payments to HSA: (See Instructions) Deduction for interest paid on student loans: (See Instructions) Contributions to lntergenerationafTntst`(See lnslrUCH Moving expenses: (Attach Federal Form 3903), , . , Self- employed health insuranceded Let orELSee nstrLcfion sl KEOGH, Self- employed SEP anaS.mp.e Plans: Forfeited interest penalty for premature vi mdrawat: Alimony/Sep. Maint. paid to : Name:• SSN: • Support for Permanently disabled individual: (Attach Form AR1000DC) Organ Donor Deduction: (Attach Form AR10000D) Arkansas Tax Deferred Tuition Savings Program TOTAL OTHER ADJUSTMENTS: Enter here and onpage AR1/NR1, Line 25 1 2 3 4 5Ons) 6 7 8 9 10 11 12 13 -- 14 (Al Youraotal Adjustments . (B) Spouse's Adjustments Status 4 Only (C) Arkansas Adjustments Only • 1, 000 1 , 000 • • • •.._ --.,....., • • • • --- • • • • - 1,000 1,000 AR1000A0J (R 11105) 100012005) AR 1000- 3V 1.61 Form Soltware Copyright 1996 - 20051-18R Block Tax Services. Inc. li HRB ARKANSAS INDIVIDUAL INCOME TAX RETURN AR3 Itemized Deduction Schedule 2005 Name JUSTIN C PIANALTO CASEY L PIANALTO Social Security Number 429-69-8352 429-59-5762 M EDI CAL AND DENTAL EXPENSES: [Do not include ekpense(s) paid by othersllsee Instructions) 1. Medical and dental expenses: 1 2. Enter amount from AR1000/AR1000NR, Line 28(A) and 28(B) 2 3. Multiply Line 2 by 7.5% (.075) 3 4. TOTAL MEDICAL EXPENSE: (Subtract Line 3 from Line 1; If Line 3 is more than Line 1, enter 0) 4e 0 TAXES: (See Instructions) 5. Real estate tax: 5 1,827 6. Personal property tax or other taxes (Attach. t 40;6 246 7. TOTAL TAXES: (Add Lines 5 and 6) ..... ,. _.,.. 7► 2,073 INTEREST EXPENSES: (See Instructions) -- -- 8. Home mortgage interest paid to financialinsrittttlons:-..�.... - - ::gig: 3,807 9. Home mortgage interest paid to an individual: Name: Address: - 9 10. Deductible points: 10 11. Investment interest: (Attach Federal Form 4952) 11 12. TOTAL INTEREST EXPENSE: (Add Lines 8 through 11) 12 le 3,807 CONTRIBUTIONS: (See Instructions) 13. Cash contributions: , - 13 14. Arland literary contributions: (See Instructions) -, 14 15. Check- oft contributions: (See Instructions) -15 16. Other: ...16 17. Carryover contributions from prior years: 17 18. TOTALCONTRIBUTIONS: (Add Unes 13 through 17) 18 ► 0 CASUALTY AND THEFT LOSSES: (See Instructions) 19. TOTAL CASUALTY AND THEFT LOSSES: (Attach Federal Form 4684) 19 0 POST- SECONDARY EDUCATION TUITION DEDUCTION(S): (See Instructions) 20. TOTAL POST- SECONDARY EDUCATION TUITION DEDUCTION(S): [Attach AR1075(s)] 20 le 0 M ISCELLANEOUS DEDUCTIONS SUBJECT T02% AGM(M IT: (See Instrdblions) ................... 21. Unreimbursed employment busiriBSsexpensest(Anacn Federal Form 2106). .-,. ,;.; 21 .. 22. Other Expenses: (List type and arno..nd , ,. -, 22 23. Add the amounts on Lines 21 and 22 Enter the total23 24. Enter the amt from AR1000/AR1000NR Line 28(A)and 28.B 24 _ _ _ _ .I 25. Multiply Line 24 above by 2% (.02) 25 26. TOTAL MISCELLANEOUS DEDUCTIONS: (Subtract Line 25 from Line 23; It Line 25 is more han Line 23, enter 0) 26 • 0 OTHER MISCELLANEOUS DEDUCTIONS: (See Instructions) 27. TOTAL MISCELLANEOUS DEDUCTIONS NOTSUBJECT TO THE 2% AGI LIMITATION. (Attach list) 27 0 TOTAL ITEMIZED DEDUCTIONS: 28. If the amount on AR1000/AR1000NR. Line 28(A) and 28(B) is $145,950 or less ($72,975 if filing separately on separate returns), add Lines 4, 7,.12.18,.19, 20-26 and.27. Enterthe.lotal It the amount on AR1000/AR1000NR, Line 28(A) and 28€B)is over $145950 ($72,975;i,rrnarried separate returns), see worksheet in the instructionSid calculate ttii32IloWWb le amodnfo enter. IF YOU CHECKED FILING STATUS 1,2,3OA6 enter 18io9owabfeartttbere andofARt[(j901AR1000NR, married here. filing separately on Enter allowable amount here. Line 29(A)28 5,880 Note: Complete your spouse lines 29 through are using 33 ONLY if you and ii:: YOUR Filing Status 4 or 5.: - ''' Adjusted Gross Income SPOUSE'S Adjusted Gross Income 29. Enter the adj gross income from AR1000/AR1000NR Une28, Cols. (A)and (B) here. 29A 36,330 29B 38,617 30. Total Arkansas adjusted gross income: (Add columns 29A and 298 from above) 30 7 4 , 9 4 7 31. Divide the amount on Line 29A by the amount on Line 30. Enter the percentage here 31 48 % 32. Multiply Line 28 by the percentage on Line 31. Enter here and on AR1000/AR1000NR, Line 29, Col. (A) (YOU) 32 2,822 33. Subtract Line 32 from Line 28, Form AR3. Enter here and an AR1000/AR1000NR, Line 29, Col. (B). Ifyou and your spouse are using Filing status 5, enter this amount on Line 29, Col. (A) of your spouse's return. (SPOUSE) 33 3,058 Page AR3 (R 11105) 1000- Sch AR3 (2005) ARA- 1V 1.61 Farm Sol ware Copyright 1996 - 2005 H&R Black Tax Services. Inc. Client Name JUSTIN C & CASEY L PIANALTd H&R BLOCK' Client SSN 429-69-8352 Peace of Mindw Extended Service Plan The Peace of Mind Extended Service Plan (the "Plan") offered by H&R Block ("Block") is available only at participating Block offices at the time your return is completed, but no later than October 31 of the year o1 the return due date. The Plan is separate from, and in addition to, Block's Standard Guarantee that pays penalty and interest resulting from an error in tax preparation. The Plan is effective when paid for and signed by you and, cannot be transferred by you to others. Subject to the exceptions noted below, the Plan provides you with the following benefits with respect to the individual federal and any individual state or local returns prepared and paid for on the date of this agreement. If your return is audited, Block will provide you with a qualified person (but not an attorney) to represent you before the tax authority should such tax authority question the accuracy of your return. If you owe additional taxes as a result of an error in tax preparation and the error 's discovered by you, your representative or a tax authority, during the period of 3 years from the filing dead) nes for such returns, not including extensions, Block will pay you for such taxes up to a cumulat've total of $5,000 for all such returns. Such 3 year limitation applies to your federal and state returns, including returns for those states in which the open period to review returns is greater than 3 years. In some cases, the correction of a specific error will involve changes on multiple returns, including State or Local tax returns, which may result in an overpayment on one return and a balance due on another. In such cases, the overpayment and balance due will be netted in determining the amount Block will pay for additional taxes owed as a result of correction of the error. Block assumes no responsibility for payment of additional taxes to a tax authority. You are responsible for providing payment of additional taxes to the tax authority. Before such payment, you must: (a) notify Block of any government notice regarding such taxes within 60 days from the date of such notice; (b) promptly provide Block with copies of such notices and other documents relating to or substantiating such additional taxes; (c) provide Block with reasonable notice of and allow Block to attend an audit with you or as your representative with Power of Attorney; (d) allow Block at its sole discretion and expense, to challenge the determination that additional taxes and penalties and interest are owed; and (e) provide Block with your receipt as proof of your purchase of the Plan. You may be required to include such payment as income on your return in an amount that will be indicated on any Form 1099 you receive from Block. Block is not responsible for the payment of any taxes you may owe on such income. The Plan applies only to filed and accepted original individual resident tax returns prepared by Block for the year of the return and for which the balance due has been paid. You represent to us that you have reviewed the items on your return and that items or issues on such returns have not been, or are not currently, under examination by tax authorities as of the date of purchase indicated on your receipt that specifies the total purchase price for the Plan and which is incorporated herein. The Plan does not apply to: (a) amended returns; 1040- NR; (b)non-individual returns such as employment (including taxes assessed on Form 4137 for income other than allocated tips), corporate, state and local small business, occupation tax, partnership. trust. estate, and gift tax returns; (c) any returns used to file for tax credits or rebates such as property tax, homestead or renters credits that are not filed in conjunction with a federal, state or local return; (d)the calculation of estimated tax payment vouchers, additional taxes owed as a result of an erroneous refund of your estimated tax payments by the IRS or a State or Local taxing authority; (e) any return for which, as of the date of such purchase, you have knowledge of additional taxes owed; (f) any return for which you have received on or before the date of such purchase any notification from any tax authority of examination or audit; (g) returns for which errors have been identified by Block prior to an assessment of additional taxes by tax authorities and can be corrected by Block within 30 days from Block's preparation of the return; (h) any return relating to previous years; POM• Extended (2005) FDPOM EX- 1V1.0 Form Solt ware Copyr fight 1996- 2005 H&R 8 lock Tax Services. Inc. page 1 of 3 JUSTIN C & CASEY L PIANALTO 429-69-8352 Peace of Mind-' ° Extended Service Plan (i) additional taxes, penalties and interest that are assessed as the result of (1) incorrect, incomplete, false or misleading information that you have given to Block in connection with its preparation of a return; Note: Peace of Mind does not cover additional taxes resulting from income omitted on a substitute W-2. (ii) the government's inability to obtain from you sufficient records to support deductions, credits and other items on your return; (iii) your failure to timely pay the taxes as shown to be clue on your return; and (iv) additional taxes assessed as the result of your desire to take a position on your return that challenges current IRS or judicial tax law guidelines or interpretation. In the event you receive a refund of any assessment that Block has paid you under the Plan, you must reimburse Block for the amount of such refund; and (j) assessments of additional taxes that occur after 3 years from the filing deadline for the return, not including extensions. Arbitration By signing below, you agree that any and all claims, disputes or controversies between you and Block (as defined below) arising out of or relating to this Plan (including, but not limited to, this document, any advertisements, promotions, or oral or written statements relating to the Plan, or the validity, enforceability or scope of this arbitration provision, including, but not limited to the issue whether any particular claim or dispute must be submitted to arbitration), whether in contract, tort or otherwise (collectively, the Claim), shall be resolved, upon the election of you or Block, by binding arbitration administered by either the American Arbitration Association (AAA) or the National Arbitration Forum (NAF) in accordance with the rules of such administrator at the time the demand is filed. The AAA rules may be accessed at www.adr.org. or by writing to AAA at 335 Madison Avenue, New York, NY 10017. The NAF rules may be accessed at www.arbforum.com or by writing to NAF, P. O. Box 50191, Minneapolis, MN 55405. In the event that a rule conflicts with this arbitration provision, this arbitration provision will govern. You have the right to select one of these arbitration administrators. Block agrees not to nvoke its right to arbitrate an individual Claim you bring in small claims court or an equivalent court, so long as the Claim is pending only in that court. This arbitration provision will not apply to any claims relating to the Plan the subject matter of which is currently being asserted in any certified class action lawsuit pending against Block as of December 1, 2004. As used in this arbitration provision, the term Block shall mean H&R Block Tax Services, Inc., its parents, wholly or majority-owned subsidiaries, affiliates and the franchisees of any of them, and each of their officers, directors, agents and employees. A neutral arbitrator shall be appointed as provided in the rules and must be a practicing attorney with more than ten years experience in tax law. The arbitration will take place in the federal judicial district in which you live. The arbitrator may award all remedies permitted by applicable substantive law, including, but not limited to, compensatory, statutory, and punitive damages, injunctive and other equitable relief and attorneys' fees and costs. No class actions or private attorney general actions in court or in arbitration, or joinder or consolidation of claims with other persons in court or in arbitration, are permitted without the written consent of the parties hereto. You will pay the first $50 of the filing fee. At your request, Block will pay the remainder of the filing tee and any administrative or hearing fees charged by the arbitration administrator, up to a maximum of $1500. If you are required to pay additional fees to the administrator, Block will consider in good faith a request by you to pay all or part of the additional fees, provided, however, that Block shall not be obligated to pay any additional fees unless the arbitrator grants you an award. If the arbitrator issues an award in Block's favor, you will not be required to reimburse Block for any fees Block has previously paid to the administrator. Except as may be required by law, neither a party nor the arbitrator may disclose the existence, content or results of any arbitration hereunder without the prior written consent of the parties. The parties acknowledge that this Plan evidences a transaction involving or affecting interstate commerce, and this arbitration provision is governed only by the Federal Arbitration Act (FAA), Title 9 of the United States Code. The arbitrator shall apply substantive law consistent with the FAA, and not any state law concerning arbitration. The arbitrator's award shall be final and not subject to appeal, except as permitted by the FAA. If any portion of this arbitration provision is deemed invalid or unenforceable, it will not invalidate the remaining portions of this arbitration provision. This arbitration provision shall only apply to this Plan and will not apply to Peace of Mind programs that you may have purchased in prior years and will not apply to prior relationships between the parties in prior years. .YOU UNDERSTAND THAT YOU HAVE THE RIGHT TO LITIGATE CLAIMS IN COURT BEFORE A JUDGE OR JURY. BY SIGNING BELOW, HOWEVER, YOU AGREE TO KNOWINGLY AND VOLUNTARILY WAIVE YOUR RIGHTS TO LITIGATE SUCH CLAIMS IN COURT BEFORE A JUDGE OR JURY AND AGREE TO RESOLVE ANY CLAIMS PURSUANT TO THE ARBITRATION PROVISION IN THIS PLAN. BY AGREEING TO THE ARBITRATION PROVISION IN THIS PLAN, YOU AGREE THAT YOU WILL HAVE NO RIGHT TO PARTICIPATE AS A REPRESENTATIVE OR MEMBER OF ANY CLASS OF CLAIMANTS PERTAINING TO ANY CLAIM SUBJECT TO ARBITRATION. POM- Extended (2005) FDPOMEX-2V 1.0 Form Sol twerp Copyright 1996. 2005 H&R Block Tax Services. Inc. page2 of 3 JUSTIN C & CASEY L PIANALTO Peace of Mind'' Extended Service Plan 429-69-8352 Satisfaction If for any reason you are not satisfied with the terms of this Plan and want to rescind this Plan, you may obtain a full refund of the fee you paid for the Plan provided that within seven (7) days from the date of purchase you contact the district manager of the H&R Block office where your tax return was prepared and provide at that . office the receipt for such payment. Claim Process - Frequently Asked Questions: I received an inquiry from a tax authority. How do I file a claim? Take your tax authority notice and any related documents to your local H&R Block office. Your local H&R Block office will file a claim with the Peace of Mind Claims Department. The claim will be reviewed and processed. It the claim is approved, you will receive a check. If the claim is not approved, you will receive a letter explaining the reason for the denial. How long will it take to process my claim? It usually takes 4 - 6 weeks to reach a claim determination. What else do I need to know? Federal law states that if your tax liability is paid by someone else, the amount of that payment becomes taxable income to you. Therefore, you will need to include your Peace of Mind payment on your tax return next year. If the payment is $600 or more you will receive form 1099-MISC from H&R Block next year. What about penalty and interest payments? Payment of any penalty and interest assessed on the additional tax due may be processed separately under the conditions of H&R Block's Standard Guarantee and paid by your local office. Who do I contact if I have more questions? You should contact the H&R Block office where your claim was originally filed. You can also speak to a client service representative by calling 1- 800- HRBLOCK. You can find additional information on our web site: www.hrblock.com/goto/peaceofmind. What if my claim is denied? You may dispute the denial by calling 1-800-HRBlock, or by submitting an email via hrblock.com, and clicking on customer support and requesting a second review. Your claim will usually be reviewed within 2 - 5 days. You will receive the final determination in writing. For New Hampshire Residents: In the event you do not receive satisfaction under this contract, you may contact the New Hampshire Insurance Department. Consumer Division, which provides oversight for consumer guaranty contracts, at 21 South Fruit Street, Suite 14, Concord NH 03301 or 603-271-2261. Client'sName(s): JUSTIN C & CASEY L PIANALTO Extended Service Plan Accepted. Extended Service Plan Declined. X Client's Signature: Spouse Signature: Signature on file Signature on file Date: Date: Tax Professional Signature: Date: POM Regular (2005) POM- Extended (2005) FDPOM EX -3V 1.0 Form Software Copyright 1996 • 2005 H&R Block Tax Services. Inc. page 3 o 3 Retirement Savings Short -Term Tax Benefit Comparison Name JUSTIN C & CASEY L PIANALTO 401(k), et. al. IRA 2005 0 0 AGI Saver's Credit Net Tax Refundable Credits Net Savings AGI Saver's Credit Net Tax Refundable Credits Net Savings 2005 SSN 2006 429-69-8352 0 No contributions 401(k) Traditional IRA Roth IRA 77,747 8,661 0 0 76,947 0 8,461 0 200 2006 _76,947 0 8,461 0 200 01 76,947 0 8,461 0 200 No contributions 401(k) Traditional IRA Roth IRA 77,747 8,372 0 0 77,747 0 8,372 0 0 77,747 0 8,372 0 0 77,747 0 8,372 0 0 The calculations on this worksheet show short-term tax savings for 2005 and 2006, taking into consideration the Saver's Credit, changes to EIC and the refundable Child Tax Credit, and changes in tax liability before credits. Long-term savings and financial considerations are not reflected. These considerations include employer matching, the benefits of tax-free distributions, and the types of investments available in different plans. R et Savings 2005) FDSCC- 1V 1.0 Form Soltw re copyright 1996 • 2005 H8B Block Tax Services. Inc. H&R BLOCK' PRIVACY POLICY Protecting your privacy is fundamental to our business at H&R Block. We honor ellapplicable privacy regulations, end wefurthet strive to operate our business In a manner that justifies your choice of H&R Block products and services. cWear providing this privacy eicy tot informs ation. required by law. This privacy policy explains the types of information we may_ you, Y Who This Policy Covers This statement applies to personal Information we collect when we provide financial products and services to customers and former customers of H&R Block Services, Ind. end Its subsidiaries that plock rovide tax preparation services In the Untied States. This policy does not apply to our affiliates, which are companies subjectto differentrregulation and/or may have different operting pracd to H&R tices. Our affiliatesncude, bcommon ut not limited to,or IH&RBI Block Digital Tabecause those xanies may be Solutions, Inc., H&R Bock Financial Advisors, Inc. and H&R Block Mortgage Corporation. Information We Collect • for exemcollect pla, your name) address and cen so rtain other at we date such are your your social security. Thls tn number, Income andto ldedu tions date, andreturn other informationaboutIncludes, you and your dependents that we need to prepare your tax return. ■ We may collect other information In connection with transactions beyond lax return preparation that you complete or propose to complete with us or our affiliates. This Information may include, for example, your name, address and certain other 'nonpub is personal Information" such as checking, debit end credit account numbers, balances and payment history, Income, assets, and social security number. • We may collect Information about you from the IRS, our franchisees, and other third parties such as credit reporting agencies In connection with transactions you complete or propose to complete with us, our franchisees, our affiliates, or non- affiliated third parties. This could include, for example, information about your tax return, tax refund, or refund anticipation loans. • s services or rour iequest Informeionfrom us, liated third ubmllarties vrebate farms, or when you enter oith whom we have business ur confess. Thiscollect lnformationtion about maynciude for exau when mple, Inquire our name, telephone number, mailing address and e- mail address. How We May Disclose Your Information H&R Block's disclosure of your information is controlled by Section 7216 of the Internal Revenue Code, the Gramm Leach Bliley Act of 1999, certain other laws, and I-I&R Block policies. Section 7216 of the Internal Revenue Code requires that We have your consent ("opt In") beforewe disclose your tax retum Information to affiliates or third parties except the Internal Revenue Service(IRS) and law enforcement offclnls, and except for certain other lawful purposes. Some Information that is identical to some of your tax return information such as name, address and social security number, may not be subject toSection 7216ewe also collect this Information for purposes other than preparing your tax return. The Gramm Leach Bliley Act of 1999 requires that we give you the option to prohibit sharing of your nonpublicersonal information for use by non-affiliated third parties for marketing purposes. This Is referred to as an "opt out" right. However, we do not share your information with non- affiliated third parties except as permitted by the Gramm Leach Bliley Act, nor do we sell or rent your Information to third parry direct marketers. For this reason, it is not necessary for us to provide you with the opportunity to opt out of having your Information shared In this manner. The Fair Credit Reporting Act(FCRA) requires us to give you the option to limit the sharing of "non- experience Information"with our affiliates. Such information Includes that which Is used, expected to be used, or collected forthe purpose of establishing your eligibilityfor consumer credit, insurance and related products end services, end Is not related solely to your transections or other communications with us. You maydirect that non- experience Information not be disclosed to I -(&R Block affiliates by not signing the Section 7216 consent described above. We may disclose your information as described below when you have provided consent under Section 7216, or es otherwise permitted by applicable laws: or consumer services disclose activities in orderrrmation to H&R to provide you with ervicelock etes enhan enhancements nts endd in kproduct opportunitiieestthat we believe may interest you. insurance or other financial II We may disclose your Information to service providers who perform businessfunctlons on our behalf, or to financial Institutions with which we havejoint marketing agreements. Services such organizations couldroduction. perform on our behalf may inciud e, for example, check printing, date processing and analysts, ire all H&R ock service tcontest hat specify apppropriate usion, end e oftyourlor e- mail information require theme to safeguard yourrldata. and prohibit them frroviders andom maknoint geters to have written contracts with us g unauthorized or unlawful use of your Information. If a state law requires us to glue you the fight to opt- out prior to any disclosure of your personal information forJoint marketing, we will not disclose you Information for such purposes without your consent. ■ We may disclose your Information to affiliates omen -affiliated third parties for other purposes permitted or required by law. Such purposes may include, for example, processing or fulfilling a service you request or selling or transferring our business or assets. We may also make your lax return information accessible to our H&R Block tax preparation affiliates end franchisees so that if you request additional tax preparation services from our affiliates or franchisees, they will be able to access your information. • If you elect to receive a refund anticipation loan, a revolving One of credit to pay your tax liability, or ifyou elect to pay your tax preparation or electronic filing fees from your tax refund, you will be presented with a loan application end agreement and/or refund processing agreement. By accepting these agreements and/or signing the consent form presented to you, you are aulhodzing H&R Block to disclose your tax return lnforntion to the lending bank. You should review these agreements end the privacy policies of the lending bank to understand how it may use and disclose your personal Information. d h ief that such disclosure • We may occur disclose with aion to affiliates or non- affiliated third court order, legal process, orotherjudiciai, administrative or arties when we have a Investigative stigttivelproceding that produces a reired quest estforrw-This Information from H&R Block. How We Protect Your Information • H&R Block maintains policies end procedures designed to restrict access to your personal information in several ways. These Include programs and stem design, passificat ons word rd protection and sical data mtsnagemenand tpracties;endottherr measures retention and disposal; computer to restrict access to the data we hod in physical and electmeasures reflected In trronic forms. How You May Control Use of Your Information H&R Block may use Information you provide (subject to your consent, where required) to communicate with you about products end services hvallable through H8R Block or third parties. If at any time you wish to limit the offers or promotions you receive from us, you may call 877-723-5458 or visit www.hrbiock.com/preferences. We will use reasonable efforts to comply with your request, although 11 may stili be necessary for us to send you Information from lime to time about transactions or accounts you have with us, our franchisees, or our affiliates. 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Tabor, Greg Date: 11/13/2006 3:16 PM Subject: Res. 183-06 Attachments: 183-06 JC Animal Farms Entertainment.pdf CC: Greg, Bell, Peggy; Deaton, Vicki; Pearman, Clarice Attached is a copy of Res. 183-06 passed by the City Council on November 7, 2006. If you have any questions please feel free to give me a call at the number listed below. Have a great day! Thanks, Amber Wood Deputy City Clerk City of Fayetteville City Clerk Division Phone: (479) 575-8323 Fax: (479) 718-7695 awood@ci.fayetteville.ar.us • •