Form 538-S - Oklahoma Claim For Credit Or Refund Of Sales Tax - 1999
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1For Office Use Only
1999 Form 538-S
Oklahoma Claim for Credit or Refund of Sales Tax
Instructions on reverse side.
Your Social Security Number
Please read carefully as an incomplete form
may delay your refund.
Spouse’s Social Security Number
Notice...
Persons who have received Temporary Assistance for
Print first name, initial and last name (first name and initial of spouse)
Needy Families (TANF) for any month in the year 1999
will not be eligible for the sales tax refund.
The Department of Human Services will make sales
Present home address (number and street, including apartment number, or rural route)
tax refunds to persons who have received aid to the
aged, blind, disabled or Medicaid payments for nursing
care from January 1, 1999 to December 31, 1999.
City, State and Zip
Part One: Taxpayer and Dependent Information
Check if you or your spouse are
Check if you or your spouse are
Oklahoma resident for the full year?
yes
no
65 years of age or over
physically disabled (submit proof)
Date lived in Oklahoma: from __________ to __________
See Instructions
Exemptions...
1. Dependents
5. Yearly
(first name, initial, last name) 2. Age 3. Social Security Number
A. Yourself ...................................
4. Relationship
Income
B. Spouse ...................................
C. Number of your
dependent children ........
D. Number of other
dependents ...................
E. Total exemptions claimed
If additional dependents are claimed, please furnish a schedule listing the information above for each.
(add A, B, C, and D) .......
Part Two: Gross Income
(Round to Nearest Dollar)
(Enter gross income and assistance received by ALL members of your household in the year 1999)
Yearly Income
1.
Enter total wages, salaries, fees, commissions, bonuses, tips, dividends and royalties
(including nontaxable earned income from your W-2) .......................................................
1.
00
2.
Enter total income from partnerships, estates and trusts, and gains from the sale or
exchange of property (taxable and nontaxable) (enclose Federal return including schedules)
2.
00
3.
Enter gross rental, business and farm income (enclose Federal return including schedules)
3.
00
4.
Enter total interest income received...................................................................................
4.
00
5.
All other yearly household income (include all other income, taxable and nontaxable,
received from each of the sources listed below:)
a.
Social Security payments (total including Medicare) ...................................................
5a.
00
b.
Veteran's Disability payments......................................................................................
5b.
00
c.
Railroad Retirement benefits........................................................................................
5c.
00
d.
Other pensions and annuities......................................................................................
5d.
00
e.
Workmen's Compensation/Loss of Time Insurance.....................................................
5e.
00
f.
Support money.............................................................................................................
5f.
00
g.
Alimony........................................................................................................................
5g.
00
h.
Public Assistance (include housing assistance, cash, etc.).........................................
5h.
00
i.
Gross income from out-of-state sources......................................................................
5i.
00
j.
Unemployment benefits................................................................................................
5j.
00
k.
1998 Earned Income Credit received in 1999..............................................................
5k.
00
l.
Total of all dependents' income....................................................................................
5l.
00
m.
Other (specify) _____________________________________ .................................
5m.
00
6.
Total gross household income (Add lines 1 - 5 m) .............................................................
6.
00
If line 6 is over limits shown in shaded box on back of form, no credit is allowed.
Part Three: Sales Tax Credit Computation
(For households with gross income below allowable limits. See shaded box on back of form.)
7.
00
7.
Total exemptions claimed in Box E above
x
$40 (credit claimed) .............
If you are required to file an Oklahoma income tax return, you must claim the amount on line 7 as a credit on Form 511, line 54 or Form
511EZ, line 16, and enclose this form with your return. If you are not required to file a return, see instructions on back of this form.
Under penalty of perjury, I declare that the information contained in this document and any attachments is true and correct to the best of my knowledge and belief.
Taxpayer’s Signature and Date
Spouse’s Signature and Date
Occupation(s)
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