Form 511nr - Oklahoma Nonresident/part-Year Income Tax Return - 2012 Page 2
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2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 2
Name(s) shown
Your Social
on Form 511NR:
Security Number:
Adjusted gross income: All Sources (from page 1, line 24) ..................................
00
25
Oklahoma
25
Standard
26
NR-C
Oklahoma Adjustments (Schedule 511NR-C, line 8) ...............................................
26
00
Deduction:
27
00
Income after adjustments (line 25 minus line 26) ....................................................
27
• Single or
28
00
Oklahoma standard or Federal itemized deductions .........
28
Married Filing
29
00
Exemptions
....
29
($1,000 x number of exemptions claimed on page 1)
Separate:
30
00
Total deductions and exemptions (add lines 28-29) ................................................
$5,950
30
Oklahoma Taxable Income: (line 27 minus line 30) ..............................................
31
00
31
• Married
32
Filing Joint
Oklahoma Income Tax from Tax Table.....................................................................
32
or Qualifying
If using Farm Income Averaging, enter tax from Form 573, line 22 and enter a “1” in box.
Widow(er):
If paying the Health Savings Account additional 10% tax, add additional tax here and enter a “2” in box.
00
STOP AND READ: If line 24 is equal to or larger than line 19, complete line 33. If line 24 is smaller than line 19, see Schedule 511NR-D.
$11,900
• Head of
33
NR-D
Oklahoma child care/child tax credit (see instructions) ...........................................
33
00
Household:
(Do not enter less than zero)
34
Subtract line 33 from line 32 (This is your tax base)
....
34
00
$8,700
Oklahoma Amount (from line 23)
Federal Amount (from line 24)
•
35
Tax percentage:
a)
b)
•
%
35
Itemized
Oklahoma Income Tax. Multiply line 34 by line 35 ................................................
00
36
36
Deductions:
37
00
Credit for taxes paid to another state (enclose Form 511TX)
37
nonresidents do not qualify
Enclose a
copy of the
38
Form 511CR - Other Credits Form -
List 511CR line number claimed here:
38
00
Federal
(Do not enter less than zero)
Schedule
Line 36 minus lines 37 and 38 .................................
..
39
39
00
.
Use tax due on Internet, mail order, or other out-of-state purchases while living in Oklahoma
40
40
00
If you certify that no use tax is due, place an ‘X’ here:
If filing an
Business Activity Tax (enclose Form 511-BAT) .......................................................
41
41
00
amended
42
Balance (add lines 39, 40 and 41) ...........................................................................
00
42
return,
(enclose W-2s, 1099s or withholding statement) .
43
Oklahoma withholding
complete
43
00
WORKSHEET
2012 Oklahoma estimated tax payments ..........................
worksheet
44
44
If you are a qualified farmer, place an ‘X’ here:
on page 4 of
00
Form 511NR.
45
2012 payment with extension ............................................
45
00
46
NR-E
Oklahoma earned income credit (Sch. 511NR-E, line 4) ...
46
00
Total payments and credits (add lines 43-46) ......................................................
47
47
00
If line 47 is more than line 42, subtract line 42 from line 47. This is your overpayment .
For further
48
48
00
information
Amount of line 48 to be applied to 2013 estimated tax .....
49
49
00
regarding
Donations from your refund
..
50
50
(Sch. 511NR-F, line 20)
NR-F
RESET NR-F
00
estimated tax,
see page 4 of
51
Total deductions from refund (add lines 49 and 50) ................................................
00
51
511NR Packet.
Amount to be refunded (line 48 minus line 51).......................................................
52
52
00
Direct Deposit Note:
Is this refund going to or through an account that is located outside of the United States?
Yes
No
Deposit my refund in my:
For Direct Deposit Information see the
511NR Packet. If you do not have your
Routing
checking account
refund deposited directly into your bank
Number:
account, you will receive a debit card.
Account
For debit card information see “All About
savings account
Number:
Refunds” in the 511NR Packet.
If line 42 is more than line 47, subtract line 47 from line 42. This is your tax due ...
53
53
00
Donation: Eastern Red Cedar Revolving Fund ........
$2
$5
$________
54
54
00
55
Donation: Public School Classroom Support Fund ..
$2
$5
$________
55
00
56
00
Underpayment of estimated tax interest (annualized installment method
) .
56
57
00
For delinquent payment (add penalty of 5% plus interest at 1.25% per month) .
57
Total tax, donation, penalty and interest (add lines 53-57) ................................
58
00
58
Under penalty of perjury, I declare the information contained in this document, and all
Place an ‘X’ in this box if the Oklahoma Tax Commission
attachments and schedules, is true and correct to the best of my knowledge and belief.
may discuss this return with your tax preparer..................
Taxpayer’s signature
Date
Spouses’s signature
Date
Paid Preparer’s signature
Date
Paid Preparer’s address and phone number
Taxpayer’s occupation
Spouse’s occupation
A COPY OF FEDERAL RETURN
Daytime Phone Number (optional)
MUST BE PROVIDED.
Paid Preparer’s PTIN
Please remit to: Oklahoma Tax Commission, P.O. Box 26800, Oklahoma City, OK 73126-0800
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