Form 538-S - Claim For Credit Or Refund Of Sales Tax - 2004

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2004
538-s
Oklahoma Claim for Credit or Refund of Sales Tax
Instructions on reverse side. Please read carefully
Your Social Security Number
as an incomplete form may delay your refund.
Part 1: Taxpayer Information
Spouse’s Social Security Number
Check if you or your spouse have a physical disability
constituting a substantial handicap to employment
Print first name, initial and last name (first name and initial of spouse)
(submit proof)
Check if you or your spouse are 65 years of age or over
Present home address (number and street, including apartment number, or rural route)
Live in Oklahoma for the entire year?
yes
no
City, State and Zip
Oklahoma resident for the entire year? yes
no
Part 2: Dependent and Exemption Information
See Instructions
1. Dependents
Qualified Exemptions...
5. Yearly
(first name, initial, last name)
2. Age 3. Social Security Number
4. Relationship
Income
A. Yourself ............................
B. Spouse ............................
C. Number of your
dependent children ..
D. Number of other
dependents .............
E. Total exemptions
claimed (add A, B,
C, and D) .................
Part 3: Gross Income:
Enter gross income and assistance, taxable and nontaxable, received by ALL members of your household in the year 2004.
Yearly Income
You may not enter negative amounts.
1.
Enter total wages, salaries, fees, commissions, bonuses, and tips
1
00
(including nontaxable income from your W-2s) .................................................................
2
00
2.
Enter total interest and dividend income received ............................................................
3
00
3.
Total of all dependents' income (from Part 2, column 5) ....................................................
4
00
4.
Social Security payments (total including Medicare) .........................................................
5
00
5.
Railroad Retirement benefits .............................................................................................
6
00
6.
Other pensions, annuities and IRAs ..................................................................................
7
00
7.
Alimony .............................................................................................................................
8
00
8.
Unemployment benefits ....................................................................................................
9
00
9.
2003 Earned Income Credit (EIC) received in 2004 and Advanced EIC received in 2004
10
00
10.
Nontaxable sources of income (specify) ________________________________ .........
11.
Enter gross income from rental, royalties, partnerships, estates and trusts, and gains
11
00
from the sale or exchange of property (taxable & nontaxable) (enclose Federal return including schedules) .
12
00
12.
Enter gross income from business and farm (enclose Federal return including schedules) .........
13
00
13.
Other (specify) _____________________________________ .....................................
00
14
14.
Total gross household income (Add lines 1-13) ...............................................................
If line 14 is over income limits shown in steps 3 and 4 on back of this form, no credit is allowed.
Part 4: Sales Tax Credit Computation
(For households with gross income below allowable limits, see steps 3 and 4 on back of form.)
15.
Total qualified exemptions claimed in Box E above
x $40 (credit claimed)
00
15
If you are filing a Form 511, carry the amount on
Direct Deposit Option:
line 15 to the Form 511, line 30.
If you would like to have the amount shown on line 15 deposited directly into your
(for those not filing a Form 511)
checking or savings account, please complete
Yes! Please deposit my refund in my
checking account
savings account
this “Direct Deposit Option” section.
Account
Routing
Number:
Number:
Under penalty of perjury, I declare that the information contained in this document and any attachments is true and correct to the best of my knowledge and belief.
If the Oklahoma Tax Commission may discuss this return
with your tax preparer, please check here:
Taxpayer’s Signature and Date
Spouse’s Signature and Date
Preparer’s Signature and Date
Occupation
Occupation

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