Form Bt-119-A - Oklahoma Waste Tire Report For Tag Agents Taxpayer Copy/worksheet

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3300200
STW
Oklahoma Waste Tire Report For Tag Agents
STW0001 -12-98-BT
BT-119-A
Taxpayer Copy/Worksheet
Revised 06-2005
A. Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
1. Total number of
vehicles registered
2. Total number of
tires exempt
-----Dollars-----
Cents
3. Tire fees
+
0 0
($1.00 per tire)
4. Tire fees
+
($3.50 per tire)
_
5. Less $1.00 for each
vehicle registered
+
D. Change
E. Out of
6. Interest
Business
+
Use this worksheet for figuring your tax, then
7. Penalty
enter the figures on the report below.
=
8. Total Due
Instructions For Completing Oklahoma Waste Tire Report For Tag Agents
Please write only in the white areas.
Line 3. Enter the total amount of tire fees
Line 7. (Penalty) - If this tax report and remittance
collected. ($1.00 per tire with a tire rim diameter of
is not postmarked within 15 days of the due date,
If any preprinted information on this report is
17
1
/2 inches or less or motorcycle, etc. tires)
a one-time 10% penalty is due. Add the amount on
incorrect, place an “X” in Box D and enter the correct
Line 3 and Line 4 together and multiply by 0.10 to
information on back of the form in the space provided.
Line 4. Enter the total amount of tire fees
determine the penalty.
collected. ($3.50 per tire with a tire rim diameter of
1
Please use a #2 pencil or pen with black ink to mark
greater than 17
/2 inches)
Line 8. (Total Due) - Total the report: Line 3 plus
your entries on this form. If you type your report,
Line 4, minus Line 5, plus Line 6 and Line 7.
please type “XXX” over “000” in Box F at the top of
Line 5. If this report and remittance is postmarked
the report below. Use the alignment box immediately
by the due date shown in Item C, you are eligible
Sign, date and detach the original report at the
after “Number of Vehicles Registered” (Line 1) to align
for a $1.00 discount for each vehicle registered.
your typewriter for typing the numbers in the
Multiply the amount on line 1 by $1.00.
perforation and mail with your payment in the
handprint boxes.
enclosed return envelope to
Line 6. (Interest) - If this tax report and remittance
If you are out of business, place an “X” in Box E
Oklahoma Tax Commission
is postmarked after the due date shown on Item C,
below.
the tax is subject to 1.25% interest per month from
Waste Tire Remittance
the due date (Item C) until it is paid. Add the
P.O. Box 26920
Line 1. Enter the total number of vehicles registered.
amount on Line 3 and Line 4 together and multiply
Oklahoma City, OK 73126-0920
by .0125 for each month or part thereof that the
Line 2. Enter the total number of tires that are
report is late.
exempt from the fee.
Instructions Continued On Back
Special Note: To insure that your report will be properly
1 2 3 4 5 6 7 8 9 0 X
processed, please print all figures within boxes as shown.
Please Detach Here and Return Report Below
Write only in white areas
Do not fold staple or papaer clip
3300200
STW
000
F.
Oklahoma Waste Tire Report for Tag Agents
A. Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
1. Total number of
vehicles registered
2. Total number of
M M D D
tires exempt
-----Dollars-----
Cents
Office Use Only
FC.
PT.
D. Change
E. Out of Business
3. Tire fees
+
0 0
($1.00 per tire)
4. Tire fees
+
($3.50 per tire)
5. Less $1.00 for each
_
vehicle registered
+
6. Interest
+
7. Penalty
Name • Address • City • State • Zip
8. Total Due
=
I declare that the information contained in this report and any attachments is true and correct to the
best of my knowledge and belief.
Sign
Here:
Date:

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