Form 511 - Oklahoma Resident Income Tax Return - 2013 Page 5
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52013 Form 511 - Resident Income Tax Return - Page 5
NOTE: Enclose this page ONLY if you have an amount shown on a schedule.
Name(s) shown
Your Social
on Form 511:
Security Number:
Donations from Refund
Schedule 511-G
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 in Schedule 511-G Information. If you are not receiving a refund, but would like to
make a donation to one of these organizations, Schedule 511-G Information lists the mailing address to mail your donation to the organization. If you are
not receiving a refund and wish to donate to the Eastern Red Cedar Revolving Fund or the Public School Classroom Support Fund, please see line 39 or
40 of Form 511.
Place an ‘X’ in the box associated with the dollar amount you wish 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 35 of Form 511, please list the line number of the organization to which
you donated. If you donate to more than one organization, please write a “99” in the box at line 35 of Form 511.
BACK TO PAGE 2
00
Oklahoma Wildlife Diversity Program ...............
$2
$5
$
...
1
?
1
00
Low Income Health Care Fund .........................
$2
$5
$
...
2
?
2
00
Oklahoma Breast and Cervical Cancer Fund ...
$2
$5
$
...
3
?
3
Support of Programs for Volunteers to Act
4
as Court Appointed Special Advocates
00
for Abused or Neglected Children.....................
$2
$5
$
...
?
4
00
Oklahoma Pet Overpopulation Fund ................
$2
$5
$
...
5
5
?
00
Support of the Oklahoma National Guard ........
$2
$5
$
...
6
?
6
00
Oklahoma Leukemia and Lymphoma Fund ......
$2
$5
$
...
7
?
7
Support of Programs for Regional Food Banks
8
00
in Oklahoma .....................................................
$2
$5
$
...
?
8
00
Support of Folds of Honor Scholarship Program
$2
$5
$
...
9
?
9
00
Y.M.C.A. Youth and Government Program .......
$2
$5
$
.
10
?
10
00
Multiple Sclerosis Society Fund........................
$2
$5
$
.
11
?
11
00
Support Oklahoma Honor Flights .....................
$2
$5
$
.
12
?
12
00
Eastern Red Cedar Revolving Fund .................
$2
$5
$
.
13
?
13
Support of Domestic Violence and Sexual
14
00
Assault Services ...............................................
$2
$5
$
.
?
14
00
Support of Volunteer Fire Departments ............
$2
$5
$
.
15
?
15
00
Oklahoma Lupus Revolving Fund ....................
$2
$5
$
.
16
?
16
00
Oklahoma Sports Eye Safety Program.............
$2
$5
$
.
17
?
17
00
Historic Greenwood District Music Festival Fund ..
$2
$5
$
.
18
?
18
00
Public School Classroom Support Fund ...........
$2
$5
$
.
19
?
19
00
Total donations (add lines 1-19, enter total here and on line 35 of Form 511) ..........
20
20
Schedule 511-H: Amended Return Information
Did you file an amended Federal return?
Yes
No
BACK TO PAGE 1
If Yes, enclose a copy of the IRS Form 1040X or 1045 AND a copy of the “Statement of Adjustment, IRS check or deposit slip. IRS
documents submitted after filing this Oklahoma amended return may delay processing.
Explain the changes to income, deductions, and/or credits below. Enter the line reference number for which you are reporting a change
and give the reason. If more space is needed, enclose a separate schedule.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Information for Schedule 511-G
1- Oklahoma Wildlife Diversity Program
2- Low Income Health Care Fund (continued)
The Oklahoma Wildlife Diversity Program is funded primarily by concerned
you may contribute toward indigent health care by sending a donation to:
Oklahomans. All donations provide for a variety of projects, including research
Oklahoma Department of Human Services, Revenue Processing Unit, Re:
on Texas horned lizards and other rare wildlife, wildlife observation activities,
Indigent Health Care Revolving Fund, P.O. Box 248893, Oklahoma City, OK
such as statewide educational workshops, informational brochures and post-
73124.
ers, and management of a bat cave purchased with previous program dona-
3- Oklahoma Breast and Cervical Cancer Fund
tions. If you are not receiving a refund, you may still support Oklahoma wildlife
You may donate for the benefit of breast and cervical cancer early detection,
by sending a donation to: Wildlife Diversity Program, 1801 North Lincoln,
public education and research. Your donation will be placed in a fund to be
Oklahoma City, OK 73105.
used for the purpose of funding programs to increase knowledge of breast and
2- Low Income Health Care Fund
cervical cancer risk and prevention and provide mammograms, pap tests and
Oklahomans helping each other is what the Indigent (Low Income) Health
biopsies for low-income women. If you are not receiving a refund, you may
Care Fund is all about. Donations made to the fund are used to help provide
still donate. Mail your contribution to: Oklahoma State Department of Health,
medical and dental care for needy children and families. Every dollar you
Breast and Cervical Cancer Revolving Fund, 1000 NE 10th Street, Oklahoma
donate goes directly for health care costs. If you are not receiving a refund,
City, OK 73152.
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