Form Bt-167 - Pledge Of Account - State Of Oklahoma Tax Commission
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1Form Number BT-167
Revised 3-2008
State of Oklahoma - Oklahoma Tax Commission
Pledge of Account
Account Holder:
Name of Permit Holder:
Financial Institution:
Permit Holder Address:
Financial Institution Address:
City
State
Zip Code
Permit Holder FEI/SSN:
Permit Number:
City
State
Zip Code
The undersigned, for the purpose of securing the payment of
taxes which are now or may be hereafter
become due to the Oklahoma Tax Commission, hereby pledges, transfers and assigns to the Oklahoma Tax Commission that certain
account or certificate of deposit maintained in the name of the undersigned at the above-named Financial Institution, being identified in
the records of the Financial Institution as Account Number
(hereinafter the “Account”).
It is understood and agreed that this pledge is limited to the sum of ($
). It is agreed that the
balance of the Account shall at all times be maintained in an amount not less that the amount above stated; however, any funds in the
Account in excess of the amount so stated shall not be considered in any way subject to this pledge.
The undersigned authorizes and directs the Financial Institution:
(a)
To reflect this pledge in its records.
(b)
To provide such verification and information regarding the Account to the Oklahoma Tax Commission as it may
reasonably require from time to time.
(c)
To hold the sum above-stated for the benefit of the Oklahoma Tax Commission and to prohibit its withdrawal by the
undersigned or any other person, unless and until written release hereof is given by the Oklahoma Tax Commission.
(d)
Upon the written demand of the Oklahoma Tax Commission, to pay the above-stated sum or any portion thereof as may
be demanded, to the Oklahoma Tax Commission.
The undersigned understands and agrees that, in the event the demand is made for the payment of any sum pursuant hereto, any
provisions under a certificate of deposit for penalty in the event of early withdrawal shall continue to apply, and such penalty will be
assigned against the remaining balance of the account; if any remaining balance is not sufficient for the payment of any such penalty,
then to the extent necessary, the penalty will be deducted from the amount payable to the Oklahoma Tax Commission.
The Account shall remain subject to this pledge until released in writing by the Oklahoma Tax Commission. This pledge shall apply to
any and all renewals, extensions, or other changes in the form of deposit of the Account, whether or not the account number is changed
as a result thereof.
Dated this
day of
,
.
Account Holder
Account Holder
Acknowledgment of Notice
The undersigned Financial Institution acknowledges receipt of a copy of the foregoing Pledge, and agrees that the Account shall be
held in accordance with the terms of the Pledge, and for the benefit of the Oklahoma Tax Commission. The Financial Institution
represents that the Account is correctly identified and is in an amount not less than that stated above.
Dated this
day of
,
.
(Seal of the Bank)
Financial Institution
Attest:
By:
Name and Title
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