Form 500-A - Income Tax Information Return

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Please print or type the name and address
Tax Year _______
Tax Year _______
of the payor in the shaded area below:
Information Return
Income Tax
520-A
500-A
Oklahoma Tax Commission
* Note: All payments with Oklahoma withholding must be reported.
Revision 2001
Revision 2000
Revision 2000
Report payments $10 or more
Report payments of $750 or more on these five items: (*see note)
on the item below: (*see note)
Lease Bonus
Royalty
Delay Rental
Working Interest
Lease
Other - please specify
Payor's Federal Identification Number
Recipient's Identification Number
State Code:
State Withholding:
Please print or type the recipient's name, address, and zip code in the area below:
County Code:
Do not use this form to report salaries
and wages. Use optional form W-2 U.S.
Treasury Dept., Internal Revenue Service
Please print or type the name and address
Tax Year _______
Tax Year _______
of the payor in the shaded area below:
Information Return
Income Tax
520-A
500-A
Oklahoma Tax Commission
* Note: All payments with Oklahoma withholding must be reported.
Revision 2001
Revision 2000
Revision 2000
Report payments $10 or more
Report payments of $750 or more on these five items: (*see note)
on the item below: (*see note)
Lease Bonus
Royalty
Delay Rental
Working Interest
Lease
Other - please specify
Payor's Federal Identification Number
Recipient's Identification Number
State Code:
State Withholding:
Please print or type the recipient's name, address, and zip code in the area below:
County Code:
Do not use this form to report salaries
and wages. Use optional form W-2 U.S.
Treasury Dept., Internal Revenue Service
Please print or type the name and address
Tax Year _______
Tax Year _______
of the payor in the shaded area below:
Information Return
Income Tax
520-A
500-A
Oklahoma Tax Commission
* Note: All payments with Oklahoma withholding must be reported.
Revision 2001
Revision 2000
Revision 2000
Report payments $10 or more
Report payments of $750 or more on these five items: (*see note)
on the item below: (*see note)
Lease Bonus
Royalty
Delay Rental
Working Interest
Lease
Other - please specify
Payor's Federal Identification Number
Recipient's Identification Number
State Code:
State Withholding:
Please print or type the recipient's name, address, and zip code in the area below:
County Code:

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