Form 215 - Oklahoma Minimum/maximum Franchise Tax Return Page 3

FRX

0600300

000

Name

Address

City

State

Zip

Federal Employer's

Identification Number

Schedule A

Corporate Officers as of ______________ are as Follows:

(date)

S S S S o o o o c c c c i i i i a a a a l l l l S S S S e e e e c c c c u u u u r r r r i i i i t t t t y y y y N N N N u u u u m m m m b b b b e e e e r r r r

P P P P r r r r e e e e s s s s i i i i d d d d e e e e n n n n t t t t

Home address (street and number, city, state, zip code)

Home Phone (area code and number)

S S S S o o o o c c c c i i i i a a a a l l l l S S S S e e e e c c c c u u u u r r r r i i i i t t t t y y y y N N N N u u u u m m m m b b b b e e e e r r r r

V V V V i i i i c c c c e e e e P P P P r r r r e e e e s s s s i i i i d d d d e e e e n n n n t t t t

Home address (street and number, city, state, zip code)

Home Phone (area code and number)

S S S S e e e e c c c c r r r r e e e e t t t t a a a a r r r r y y y y

S S S S o o o o c c c c i i i i a a a a l l l l S S S S e e e e c c c c u u u u r r r r i i i i t t t t y y y y N N N N u u u u m m m m b b b b e e e e r r r r

Home address (street and number, city, state, zip code)

Home Phone (area code and number)

T T T T r r r r e e e e a a a a s s s s u u u u r r r r e e e e r r r r

S S S S o o o o c c c c i i i i a a a a l l l l S S S S e e e e c c c c u u u u r r r r i i i i t t t t y y y y N N N N u u u u m m m m b b b b e e e e r r r r

Home address (street and number, city, state, zip code)

Home Phone (area code and number)

N N N N o o o o t t t t e e e e : : : : I I I I f f f f a a a a d d d d d d d d i i i i t t t t i i i i o o o o n n n n a a a a l l l l s s s s p p p p a a a a c c c c e e e e i i i i s s s s n n n n e e e e e e e e d d d d e e e e d d d d , , , , p p p p l l l l e e e e a a a a s s s s e e e e a a a a t t t t t t t t a a a a c c c c h h h h a a a a s s s s c c c c h h h h e e e e d d d d u u u u l l l l e e e e i i i i n n n n t t t t h h h h e e e e s s s s a a a a m m m m e e e e f f f f o o o o r r r r m m m m a a a a t t t t . . . .

Mandatory inclusion of social security and/or federal identification numbers are required on forms filed with the Oklahoma

Tax Commission pursuant to Title 68 of the Oklahoma Statutes and rules thereunder, for identification purposes, and are

deemed part of the confidential files and records of the Oklahoma Tax Commission.