“(1) If you are entitled to a refund, check if you wish to designate [ ] $1, [ ] $5, [ ] $10, [ ] $_______ (write in amount), or [ ] all refund due of your tax refund for the Arkansas Game and Fish Foundation. Your refund will be reduced by this amount.
(2) If you owe an additional amount, check if you wish to contribute an additional [ ] $1, [ ] $5, [ ] $10, [ ] $_______ (write in amount) for the Arkansas Game and Fish Foundation. If you wish to make a contribution to the foundation, you must enclose a separate check for the amount of your contribution, payable to the Arkansas Game and Fish Foundation.”