Form 538-S Draft - Claim For Credit/refund Of Sales Tax - 2012
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1
2Barcode Placement
#1695#
State of Oklahoma
Claim for Credit/Refund of Sales Tax
538 s
2
Taxpayer Social
If died in 2012 or 2013,
Instructions on page 2.
Security Number
enter date of death:
0
Please read carefully as
an incomplete form may
1
If died in 2012 or 2013,
Spouse’s Social
delay your refund.
2
enter date of death:
Security Number
Part 1: Taxpayer Information
Taxpayer first name, middle initial and last name
Physical address in 2012 (if different than shown in mailing address section)
Spouse’s first name, middle initial and last name (if a joint return)
Check if you or your spouse have a physical disability
Mailing address (number and street, including apartment number, or rural route)
constituting a substantial handicap to employment (submit proof)
Check if you or your spouse are 65 years of age or over
City, State and Zip
Oklahoma resident for the entire year?
yes
no
Exemption Information
Part 2: Dependent
Note: Do not enter the taxpayer or spouse as a dependent.
Qualified Exemptions...
1. Dependents
See Instructions
5.Yearly
A. Yourself ............................
(first name, middle initial, last name) If you have
2. Age 3. Social Security Number
4. Relationship
Income
additional dependents, please attach schedule.
B. Spouse .............................
C. Number of your
dependent children...
D. Number of other
dependents ..............
E. Total exemptions
claimed (add A-D) ....
Part 3: Gross Income:
Enter taxable and nontaxable gross income and assistance received by ALL members of your household in the year 2012.
Yearly Income
See “Total gross household income” definition on page 2 for examples of income.
You may not enter negative amounts.
1. Enter total wages, salaries, fees, commissions, bonuses, and tips
1
(including nontaxable income from your W-2s) ......................................................................
00
2
00
2. Enter total interest and dividend income received ...................................................................
3
00
3. Total of all dependents’ income (from Part 2, column 5) ..........................................................
Draft
00
4
4. Social Security payments (total including Medicare) ...............................................................
00
5
5. Railroad Retirement benefits ...................................................................................................
8/15/12
6
00
6. Other pensions, annuities and IRAs ........................................................................................
00
7
7. Alimony ....................................................................................................................................
00
8
8. Unemployment benefits ...........................................................................................................
00
9
9. 2011 Earned Income Credit (EIC) received in 2012 .................................................................
00
10
10. Nontaxable sources of income (specify) _________________________________ ..............
You may not enter negative amounts.
11. Enter gross (positive) income from rentals, royalties, partnerships, estates & trusts, and gains
11
00
from the sale or exchange of property
.......
(taxable & nontaxable) (enclose Federal return including schedules)
12
00
12. Enter gross (positive) income from business and farm
.........
(enclose Federal return including schedules)
13
00
13. Other income -including income of others living in your household (specify) _____________
14. Total gross household income (Add lines 1-13) ...................................................................
14
00
If line 14 is over income limits shown in steps 2 and 3 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 2 and 3 on back of form.)
15. Total qualified exemptions claimed in Box E above
x $40 (credit claimed) ..........
15
00
For those NOT filing a Form 511.
Direct Deposit Option:
If you are filing a Form 511, carry the credit to Form 511, line 27.
See page 2 for Refund Information.
Deposit my refund in my:
Routing
Is this refund going to or through an
Number:
account that is located outside of
checking account
the United States?
Account
savings account
Yes
No
Number:
If the Oklahoma Tax Commission may discuss this return
Under penalty of perjury, I declare the information contained in this document and any attachments is true and correct to the best of my knowledge and belief.
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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