Form 511nr - State Of Oklahoma Income Tax Return

2003 Form 511NR • page 5

Name(s) shown on Form 511NR

Your Social

Security Number

Donations from Refund

Schedule 511NR-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 below and on the back of this form (Schedule

511NR-G Information). If you are not receiving a refund, but would like to make a donation to one of these charities, Schedule 511NR-

G 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 57 of Form 511NR.

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 53 of Form 511NR,

please listed the line number of the charity to which you donated. Example: If you donated to the Oklahoma Breast Cancer Program,

write a “4” in the oval on line 53 of Form 511NR. If you donate to more than one charity, please write a “99” in the oval on line 53 of

Form 511NR.

Oklahoma Wildlife Diversity Program . . . . . . . . . . . . .

$_____ . . . .

Low Income Health Care Fund . . . . . . . . . . . . . . . . . .

$_____ . . . .

Veteran Affairs Capital Improvement Program. . . . . . .

$_____ . . . .

Oklahoma Breast Cancer Program . . . . . . . . . . . . . . .

$_____ . . . .

Oklahoma City Bombing Memorial Fund . . . . . . . . . . .

$_____ . . . .

Oklahoma Organ Donor Education Fund . . . . . . . . . .

$_____ . . . .

Oklahoma School for the Blind/Oklahoma School for the Deaf

$_____ . . . .

Tulsa Reconciliation Education and Scholarship Trust Fund

$_____ . . . .

Silver Haired Legislature Program . . . . . . . . . . . . . . .

$_____ . . . .

Total donations (add lines 1-9, enter total here and on line 53 of Form 511NR) . . . . . . .

Schedule 511NR-G

Information

Oklahoma Wildlife Diversity Program

The Oklahoma Wildlife Diversity Program is funded primarily by concerned Oklahomans. All donations

provide for a variety of projects, including research on Texas horned lizards and other rare wildlife, wildlife

observation activities, such as statewide educational workshops, informational brochures and posters, and

management of a bat cave purchased with previous program donations.

If you are not receiving a refund, you may still support Oklahoma wildlife by sending a donation to:

Wildlife Diversity Program, 1801 North Lincoln, Oklahoma City, OK 73105.

Low Income Health Care Fund

Oklahomans helping each other is what the Indigent (Low Income) Health Care Fund is all about. Dona-

tions made to the fund are used to help provide medical and dental care for needy children and families.

Every dollar you donate goes directly for health care costs.

If you are not receiving a refund, you may contribute toward indigent health care by sending a donation to:

Oklahoma Department of Human Services, Revenue Processing Unit, Re: Indigent Health Care Revolving

Fund, P.O. Box 25352, Oklahoma City, OK 73125.

Continued...

Form 511nr - State Of Oklahoma Income Tax Return - 2003 Page 5

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