Form 511 - State Of Oklahoma Income Tax Return - 2004 Page 5
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52004 Form 511 • Page 5
Name(s) shown on Form 511
Your Social
Security Number
Earned Income Credit
Schedule 511-G
Computation Worksheet
You are allowed a credit equal to 5% of the Earned Income Credit allowed on your Federal return.
The credit must be prorated on the ratio of Oklahoma AGI to Federal AGI. Enclose a copy of your Federal return.
00
Federal earned income credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
1
00
Multiply line 1 by 5% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
2
Divide the amount on line 7 of Form 511 by the amount on line 1 of Form 511
3
•
•
%
3
Enter the percentage from the above calculation here
. . . . .
(do not enter more than 100%)
00
Oklahoma earned income credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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4
(multiply line 2 by line 3, enter total here and on line 32 of Form 511)
Donations from Refund
Schedule 511-H
This schedule allows you to make a donation from your refund to a variety of Oklahoma organizations. Information regarding each
program, their mission, how funds are utilized, and their mailing address are shown on the back of this form (Schedule 511-H Informa-
tion). If you are not receiving a refund, but would like to make a donation to one of these charities, Schedule 511-H Information lists the
mailing address to mail your donation to the organization. If you are not receiving a refund and are wishing to donate to the Oklahoma
Organ Donor Education Fund, please see line 40 of Form 511.
Please check the box associated with the dollar amount you are wishing to have deducted from your refund and donated to that
organization. Then carry that figure over into the column at the right. When you carry your figure back to line 36 of Form 511, please
list the line number of the charity to which you donated. If you donate to more than one charity, please write a “99” in the oval on line 36
of Form 511.
Oklahoma Wildlife Diversity Program . . . . . . . . . . . . .
$2
$5
$_____ . . . .
00
1 1 1 1 1
1
Low Income Health Care Fund . . . . . . . . . . . . . . . . . .
$2
$5
$_____ . . . .
00
2 2 2 2 2
2
Veterans Affairs Capital Improvement Program. . . . . .
$2
$5
$_____ . . . .
00
3 3 3 3 3
3
Oklahoma Breast and Cervical Cancer Fund . . . . . . .
$2
$5
$_____ . . . .
00
4 4 4 4 4
4
00
Oklahoma City Bombing Memorial Fund . . . . . . . . . . .
$2
$5
$_____ . . . .
5 5 5 5 5
5
00
Oklahoma Organ Donor Education Fund . . . . . . . . . .
$2
$5
$_____ . . . .
6 6 6 6 6
6
00
Okla. School for the Blind/Okla. School for the Deaf
$2
$5
$_____ . . . .
7 7 7 7 7
7
00
Tulsa Reconciliation Educ. & Scholarship Trust Fund
$2
$5
$_____ . . . .
8 8 8 8 8
8
Oklahoma Silver Haired Legislature Program . . . . . .
$2
$5
$_____ . . . .
00
9 9 9 9 9
9
Support of Oklahoma Common Schools . . . . . . . . . .
$2
$5
$_____ . . . .
00
10
10
10
10
10
10
Support of Oklahoma Road & Highway Maintenance
$2
$5
$_____ . . . .
00
11
11
11
11
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11
Support of Oklahoma Medicaid Program . . . . . . . . . .
$2
$5
$_____ . . . .
00
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12
12
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12
00
County Fair Enhancement Fund . . . . . . . . . . . . . . . . .
$2
$5
$_____ . . . .
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13
00
Junior Livestock Auction Scholarship Fund . . . . . . . .
$2
$5
$_____ . . . .
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Support of Programs for Volunteers to Act as Court Appointed Special Advocates
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for Abused or Neglected Children . . . . . . . . . . . . . . . .
$2
$5
$_____ . . . .
00
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Oklahoma Pet Overpopulation Fund . . . . . . . . . . . . . .
$2
$5
$_____ . . . .
00
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Total donations (add lines 1-16, enter total here and on line 36 of Form 511) . . . . . . . .
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