A. Yourself.............................
B. Spouse..............................
C. Number of your
dependent children...
D. Number of other
dependents...............
E. Total exemptions
claimed (add A-D).....
Instructions on reverse.
Please read carefully as
an incomplete form may
delay your refund.
1. Dependents
(first name, middle initial, last name) If you have
additional dependents, please attach schedule. 2. Age 3. Social Security Number
5.Yearly
Income
Part 3: Gross Income:
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.
Taxpayer’s Signature and Date Spouse’s Signature and Date
Preparer’s Signature and Date
See Instructions
Part 2: Dependent
Qualified Exemptions...
1. Enter total wages, salaries, fees, commissions, bonuses, and tips
(including nontaxable income from your W-2s) .......................................................................
2. Enter total interest and dividend income received ...................................................................
3. Total of all dependents’ income (from Part 2, column 5)...........................................................
4. Social Security payments (total including Medicare) ................................................................
5. Railroad Retirement benefits ....................................................................................................
6. Other pensions, annuities and IRAs .........................................................................................
7. Alimony ...................................................................................................................................
8. Unemployment benefits ...........................................................................................................
9. 2010 Earned Income Credit (EIC) received in 2011..................................................................
10. Nontaxable sources of income (specify) __________________________________...............
11. Enter gross (positive) income from rental, royalties, partnerships, estates & trusts, and gains
from the sale or exchange of property (taxable & nontaxable) (enclose Federal return including schedules)........
12. Enter gross (positive) income from business and farm (enclose Federal return including schedules) ..........
13. Other income -including income of others living in your household (specify)_____________
14. Total gross household income (Add lines 1-13)....................................................................
Part 4: Sales Tax Credit Computation
If you are filing a Form 511, carry the credit to Form 511, line 27.
If the Oklahoma Tax Commission may discuss this return
with your tax preparer, please check here:
Occupation Occupation
Part 1: Taxpayer Information
15. Total qualified exemptions claimed in Box E above x $40 (credit claimed) ..........
If line 14 is over income limits shown in steps 2 and 3 on back of this form, no credit is allowed.
00
00
See “Total gross household income” definition on back for examples of income.
Claim for Credit/Refund of Sales Tax
Taxpayer Social
Security Number
Spouse’s Social
Security Number
FORM
2011
Taxpayer first name, middle initial and last name
Mailing address (number and street, including apartment number, or rural route)
City, State and Zip
Spouse’s first name, middle initial and last name (if a joint return)
Check if you or your spouse have a physical disability
constituting a substantial handicap to employment (submit proof)
Check if you or your spouse are 65 years of age or over
Oklahoma resident for the entire year? yes no
Direct Deposit Option: For those NOT filing a Form 511.
See page 2 for Refund Information.
Physical address in 2011 (if different than shown in mailing address section)
Exemption Information
538 s
4. Relationship
1
23456789
10
11
12
13
14
Yearly Income
You may not enter negative amounts.
You may not enter negative amounts.
15
Enter taxable and nontaxable gross income and assistance received by ALL members of your household in the year 2011.
Note: Do not enter the taxpayer or spouse as a dependent.
00
00
00
00
00
00
00
00
00
00
00
00
00
(For households with gross income below allowable limits, see steps 2 and 3 on back of form.)
Routing
checking account Number:
savings account Account
Number:
Deposit my refund in my:
State of Oklahoma
Is this refund going to or through an
account that is located outside of
the United States?
Yes No
If died in 2011 or 2012,
enter date of death:
#1695#
If died in 2011 or 2012,
enter date of death:
Form 538-S Instructions
Follow the steps below to determine if you (or your spouse) are eligible to take the Sales Tax Relief/Credit.
Step 1 Were you a resident of Oklahoma* (defined below) for the entire year?
Yes (go to step 2) No (you do not qualify to file this form)
Step 2 Is your total gross household income* (defined below) $20,000 or less?
Yes (File Form 538-S) No (go to step 3)
Step 3 Is your total gross household income* (defined below) $50,000 or less and at least one of the following applies?
• You can claim an exemption for your dependent.
• You and/or your spouse are 65 years of age or older by 12/31/2011.
• You have a physical disability constituting handicap to employment (provide proof* as defined in the section below)
Yes (File Form 538-S) No (you do not qualify to file this form)
Note: Extensions do apply to this form. If you have been granted an extension of time in order to file your income tax return (including
the April 20th due date for electronically filed returns), file this form with your income tax return on or before the due date granted
by the extension. Enclose a copy of the extension.
Notice
• Persons who have received TANF (Temporary Assistance for Needy Families) for any month in the year of 2011 will not be
eligible for the sales tax credit or refund. Your monthly TANF benefit included Sales Tax Relief money.
• The Department of Human Services will make sales tax refunds to persons who have continuously received aid to the aged,
blind, disabled or Medicaid payment for nursing home care from January 1, 2011 to December 31, 2011.
GO STOP
GO
GO
STOP
STOP
*Definitions for the purpose of this form:
Resident of Oklahoma is defined as a person legally domiciled in this state for the entire tax year.
Household means any house, dwelling or other type of living quarters.
Total gross household income means the total amount of gross income received by ALL persons living in the same household whether
the income was taxable or not for income tax purposes. This includes, but is not limited to, public assistance payments, support money
(example: child support), workmen’s compensation, school grants or scholarships, veteran’s disability compensation, loss-of-time insurance
payments and all of the types of income shown on the front of this form. Income that is exempt must be included in the year received,
for example: nontaxable sources of income on your W-2 (such as a dependent care reimbursement account), military housing assistance,
and the distribution of earnings from a Roth IRA. Note: Do not include income deferred for Federal Income Tax purposes, for example: tax
deductible contributions to a 401K or to a traditional IRA. This income will be included when distributed and taxed on your Federal return.
Proof of disability may be established by certification by an agency of State Government, an insurance company or a physician, or by eligibility
to receive disability benefits under the Federal Social Security Act. A veteran certified by the Veterans Administration of the Federal
government as having a service-connected disability shall constitute proof.
Filing instructions and due date:
If you are required to file an Oklahoma Income Tax Return, claim the sales tax refund as a credit on your tax return, Form 511, and enclose
this signed form. Your return claiming the sales tax credit must be filed no later than April 17th. (See note at bottom of page).
If you are not required to file an Oklahoma Income Tax Return, this form must be filed no later than July 2nd. If you have withholding or
made estimated payments and are filing for a refund on Form 511, you must claim the sales tax credit on your return and enclose this
signed form. If you are not filing an income tax return, mail this completed and signed form to: Oklahoma Tax Commission, Post Office Box
26800, Oklahoma City, OK 73126-0800.
Refund Information for those Not Filing a Form 511:
• If you are not filing a Form 511, and would like to have the amount shown on line 15 deposited directly into your checking or savings
account, complete the “Direct Deposit Option” section. (If you are filing a Form 511, you will complete the Direct Deposit section on the
Form 511). If you do not choose direct deposit, you will receive a debit card. Taxpayers filing a joint return will each receive a card in
their name. Each card will have access to the full amount of the refund.
• WARNING! The Oklahoma Tax Commission will not allow direct deposits to or through foreign financial institutions. If you use a foreign
financial institution or have a foreign address on your income tax return, your refund will be mailed to the address shown on your return. If
you have an address with an APO, FPO or DPO, you are not considered to have a foreign address; your refund is eligible for direct deposit.
Exceptions:
• A person convicted of a felony and who is an inmate in the custody of the Department of Corrections for any portion of the year is not
eligible to file a claim for the sales tax relief.
• Individuals living in Oklahoma under a visa do not qualify for the sales tax relief.
• If a taxpayer or spouse died during the tax year, he/she will not qualify for the sales tax credit. If the death occurred after December 31,
2011, but before this tax form was filed, the sales tax credit or refund for the deceased will be issued to their estate. Enter the date of
death in the box next to the taxpayer and/or spouse’s Social Security Number.
Dependents:
To qualify as a dependent for the sales tax credit or refund, you must qualify and be claimed as a dependent for Federal income tax purposes.
The name, social security number, age, relationship and yearly income (if any) must be entered for all dependents. All of the other
sales tax credit or refund requirements listed above must also be met (example: resident of Oklahoma for the entire year). Do not enter the
taxpayer or spouse as a dependent.
The Oklahoma Tax Refund Debit Card!
Oklahoma’s Newest Way to Receive Your Refund...
The Oklahoma Tax Commission is offering a debit
card as an alternative to direct deposit for income
tax refunds starting January 2012. While direct
deposit of your refund into your checking or
savings account has been the preferred payment
method by many people, the Oklahoma Tax Refund
debit card will now be issued for those not choosing
that option when filing a return. **
• Safe, convenient and secure, the debit card can be used at your favorite stores and ATM’s that accept
MasterCard debit cards. That includes places like the gas station, grocery store, department store,
on-line stores and many more.
• Deposit or cash your debit card free at banks or financial institutions that accept MasterCard; or go
online to www.goprogram.com and transfer your refund to your checking/savings account for a fee
of $0.75.
• You can also withdraw the funds from the card free of charge from any MoneyPass ATM location in
Oklahoma. MoneyPass locations can be found at www.moneypass.com. In some cases a fee may apply
at ATM’s not affiliated with MoneyPass.
• Make a bill payment using funds from the card by going online at www.goprogram.com. A fee of $0.25
will be assessed per transaction.
Just remember – all you need to do is activate your card, pick a PIN, and sign the back of your card.
One Card - Many Options for Use...
Activate Your Debit Card and Pick a PIN...
Your Oklahoma Tax Refund debit card is ready for use once you’ve activated it following these three easy steps:
1) Call 1-888-929-2460
2) Provide some basic information and the last 4 digits of your social security number
3) Pick your PIN
Card Replacement...
If your card is lost, stolen or misplaced call 1-888-929-2460 to get a new one. The first replacement card is
free; subsequent card replacement requests will include a charge of $4.00 per card.
Inactivity Fees May Apply...
Inactivity fees of $1.50 per month will apply if your card is not used for a period of 60 days. To avoid these
fees use your card immediately or at least once every 60 days. Your card is good for three years from the
date of issue.
**Beginning in late January paper refund checks will no longer be issued for individual tax filers. Instead
taxpayers must select to have refunds directly deposited in an account with a financial institution or opt to
receive a debit card.
More information on the Oklahoma Tax Refund Debit Card can be found at www.tax.ok.gov.
