Form Ow-15 - Oklahoma Nonresident Member Withholding Exemption Affidavit Page 2
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3OW-15
State of Oklahoma
Nonresident Member Withholding
Revised 1-2009
Exemption Affidavit
Part A: Pass-through Entity Information
Name of S-Corporation, Partnership, Limited Liability Company or Trust
Federal Identification Number
Address
Type of Pass-through Entity (check one)
S-Corporation
Partnership
Limited Liability Company
Trust
Other
Part B: Nonresident Member Information
Name of Partner, Shareholder, Member or Beneficiary
Social Security or Federal Identification Number
Address
Part C: Withholding Tax Exemption
I,
, as a nonresident member of the above named pass-through entity, request to
be exempt from the Oklahoma income tax withholding requirement found in Title 68 O.S. Section 2385.30
for tax year
, and all subsequent years, until I notify the Tax Commission of a change in this election.
By signing this affidavit I agree to be subject to the personal jurisdiction of the Tax Commission in the courts of
this state for the purpose of determining and collecting any Oklahoma taxes, including estimated tax payments,
together with any related interest and penalties.
I agree to timely file appropriate income tax returns, or be included in the pass-through entity’s income tax
return, and make payment of all Oklahoma taxes as required by law.
If I fail to abide by the terms of this affidavit I understand that the Tax Commission may revoke the withholding
exemption granted under Title 68 O.S. Section 2385.30 at any time.
Part D: Withholding Tax Exemption Revocation
I,
, as a nonresident member of the above named pass-through entity, hereby
revoke my previous withholding election dated
. At this time, I request to be subject
to withholding on my share of distributed Oklahoma income of the above named pass-through entity for tax
year
, and all subsequent years, until I notify the Tax Commission of a change of this election.
Part E: Signature
Signature of Nonresident Member
Date
Daytime Phone Number (
)
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