Form Oes-33 - Refund Application - State Of Oklahoma
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1OES-33 (Rev. 9-04)
State of Oklahoma
OKLAHOMA EMPLOYMENT SECURITY COMMISSION
P.O. Box 52003
Oklahoma City OK 73152-2003
RESET
REFUND APPLICATION
See reverse side for instructions
Firm Name
Account No.
Address
City
State
ZIP Code
AMOUNT OF REFUND CLAIMED: $________________. NOTE: DO NOT USE THIS CREDIT on subsequent
reports. Using this credit on subsequent reports could cause interest charges at a later date.
Firm:
Date:
Signature:
Title:
Subscribed and sworn to before me this : _______ day of _________________, 20____
Notary Public: ______________________________ My Commission Expires:______________
FOR COMMISSION USE ONLY
Refund is hereby [__] granted [__] denied in the amount of $___________________ for the following reason
________________________________________________________________________________________
________________________________________________________________________________________
Verified: ________________________________ Date: _____________
0033
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