Form 511x - Oklahoma Amended Resident Individual Income Tax Return - 2012 Page 3

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2012 Form 511X - Page 2

Amended Resident Income Tax Return

As Originally

Office Use Only

Reported or as

Amended

Previously Adjusted

16 Enter total tax from line 15D .........................................

Use Tax due on Internet, mail order, or other out-of-state purchases

18 Business Activity Tax .....................................................

19 Total Tax: Add lines 16, 17 and 18. Enter total here ......

Payments...

20 Oklahoma income tax withheld .....................................

21 Oklahoma estimated tax paid plus amount paid

with extension ...............................................................

22 Amount paid with original return plus additional paid

after it was filed .............................................................

23 Refundable credits (see instructions) ............................

24 Total of lines 20 through 23 ...........................................

Refund or Amount You Owe...

25 Overpayment, if any, as shown on original return or as previously adjusted

by Oklahoma (see instructions) ....................................................................

26 Subtract line 25 from line 24 .........................................................................

27 Refund: If line 26 is more than line 19 enter difference (see instructions) ....

Want a Faster Refund?

Is this refund going to or through an account that is located outside of the United States?

Yes

Deposit refund in my:

Elect to have your refund directly deposited

into your checking or savings account.

checking account

Routing

Number:

If you do not choose direct deposit, you will

receive a debit card. For more information

Account

see the instructions for line 27.

savings account

Number:

28 Tax liability: If line 19 is more than line 26 enter difference ...........................

29 Interest: 1.25% per month from _______________ to ________________

30 Total amount due (add lines 28 and 29).Please pay in full with this return

If you are changing your Oklahoma return due to a change to your

STOP

Federal return, enclose proof that the IRS approved the change.

Please check here if the Oklahoma Tax

Explain the changes to income, deductions, and/or credits below or, if necessary, attach a

Commission may discuss this return with

separate schedule. Enter the line reference number for which you are reporting a change

your tax preparer.

and give the reason for each change in Column “B”.

The Oklahoma Tax Commission is not required to give actual notice to taxpayers of changes in any state tax law.

Remit to: Oklahoma Tax Commission, PO Box 26800, Oklahoma City, Oklahoma 73126-0800

Under penalties of perjury, I declare I have filed an original return and I have examined this return including accompanying schedules and statements, and to the best of my knowledge this amended return

is true, correct and complete.

Declaration of preparer (other than taxpayer) is based on all information of which the preparer has any knowledge.

Preparer’s signature

Date

Taxpayer signature

Date

Preparer’s printed name

Spouse’s signature (if filing jointly both must sign)

Date

Preparer’s Address

Daytime Phone Number (optional)

(