Form 500-B - Report Of Nonresident Member Income Tax Withheld - 2009

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Barcode Placement
State of Oklahoma
Information Return
500-B
Report of Nonresident Member Income Tax Withheld
Revised 2009
Tax Year End Date of Partnership, S Corporation, LLC or Trust _________________
Part A: Pass-Through Entity Information
Part B: Nonresident Member Information
Name of Pass-Through Entity:
Name:
Type of Taxpayer:
Type of Ownership:
Individual
LLC
Corporation
Trust
Partnership
S Corporation
LLC
Trust
Other (specify)
______________
Other (specify) ______________________________________________
Federal Identification Number:
Social Security Number or Federal Identification Number of Member:
Street Address:
Street Address:
City
State
Zip
City
State
Zip
Part C: Distribution and Withholding
Oklahoma Income Tax Withheld:
Total Amounts Distributed from Oklahoma Sources:
The nonresident member must enclose Form 500-B with their Oklahoma income tax return to substantiate the withholding.
Barcode Placement
State of Oklahoma
Information Return
500-B
Report of Nonresident Member Income Tax Withheld
Revised 2009
Tax Year End Date of Partnership, S Corporation, LLC or Trust _________________
Part A: Pass-Through Entity Information
Part B: Nonresident Member Information
Name of Pass-Through Entity:
Name:
Type of Taxpayer:
Type of Ownership:
Individual
LLC
Corporation
Trust
Partnership
S Corporation
LLC
Trust
Other (specify)
______________
Other (specify) ______________________________________________
Federal Identification Number:
Social Security Number or Federal Identification Number of Member:
Street Address:
Street Address:
City
State
Zip
City
State
Zip
Part C: Distribution and Withholding
Oklahoma Income Tax Withheld:
Total Amounts Distributed from Oklahoma Sources:
The nonresident member must enclose Form 500-B with their Oklahoma income tax return to substantiate the withholding.

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