STC0008-1092-BT
State of Oklahoma
Oklahoma Tax Commission
BT-144-C
2501 Lincoln Boulevard
Oklahoma Tax Commission
Revised 7-05
Oklahoma City, OK 73194-0010
Over the Counter Purchase
of Coin-Operated Device Decal(s)
Office Use
Approved
Name
FEI/SSN
Disapproved
Address
Status
City, State, Zip
Coin Device Account Number
Number of Decals
Issued
Number and Type of Devices Operated - Full Price
A
Type Decal
Full Price
Number of Decals
Amount
B
C
Type A Decal
Music, Amusement or
D
$50.00
$
Vending (25 cents or more)
E
Type B Decal
$10.00
$
Vending (less than 25 cents)
Beginning Number
Type C Decal
A
Bulk Vending (25 cents or more)
$15.00
$
with 2-5 mechanisms
B
C
Type D Decal
$ 5.00
$
D
Bulk Vending (25 cents or more)
E
Type E Decal
$ 2.00
$
Bulk Vending (less than 25 cents)
Ending Number
Special Decals (for 30 day periods)
A
Type Decal
Number of Decals Number of Periods
Price
Amount
B
$
$5.00 per period
Type A Decal
C
D
$
$1.00 per period
Type B Decal
E
$
$1.50 per period
Type C Decal
$
$0.50 per period
Type D Decal
Amount Received
$
$0.20 per period
Type E Decal
Inclusive date of periods for special decals
/
/
through
/
/
Issued By
Number of Machines
Penalty
Penalty for Sealed Machine
X $100.00 = $
Total Amount Remitted for Decal Fees and Penalty
Received By
A decal must be firmly affixed to each coin operated device placed in operation or on location,
and must be visible to and readable by the public. All decals expire on June 30.
Date Received
Date Mailed
Signature/Title (or Sole Owner, Partner, or Corp Officer)
Date of Application
Mandatory inclusion of social security and/or federal identification numbers are required on forms filed with the Oklahoma Tax
Commission pursuant to Title 68 of the Oklahoma Statutes and regulations thereunder, for identification purposes, and are
deemed part of the confidential files and records of the Oklahoma Tax Commission.
Please put your FEI/SSN on your check to
The Oklahoma Tax Commission is not required to give actual
assure proper credit to your account.
notice to taxpayers of changes in any state tax law.
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