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#1695#

Oklahoma Nonresident/ Part-Year Income Tax Return

Form 511NR - 2012

Your Social Security Number

Spouse’s Social Security Number

(joint return only)

Place an ‘X’ in this box if this taxpayer

is deceased

Place an ‘X’ in this box if this taxpayer

is deceased

AMENDED

RETURN!

If iling an Amended Return,

enclose a copy of your Federal Amended Return and IRS acceptance.

Place an ‘X’ in this box if this is an

AMENDED

511NR:

and Address	Print or Type
Name	Please

Filing Status


Residency Status

Your irst name, middle initial and last name

If a joint return, spouse’s irst name, middle initial and last name

Mailing address (number and street, including apartment number, rural route or PO Box)

City, State and Zip

1Single

2Married iling joint return (even if only one had income)

3 Married iling separate

•If spouse is also ﬁling,

list SSN and name in box:

4Head of household with qualifying person

5 Qualifying widow(er) with dependent child

•Please list the year spouse died in box at right:

Nonresident(s) State of Residence: ________________

Part-Year Resident(s) From ___________ to _________

Resident/Part-Year Resident/Nonresident

State of Residence: Yourself _________ Spouse _______

Not Required to File

Place an ‘X’ in this box if you do not have an Oklahoma iling requirement and are iling for refund of State withholding.

(see instructions)

*NOTE: If claiming Special Exemption, see instructions on page 8 of 511NR Packet.

Regular * Special

Blind

Exemptions

Add the Totals from

Yourself

the 4 boxes.

Write the Total

in the box below.

Total

Spouse

Number of dependent children

NOTE: IF YOU MAY

BE CLAIMED AS A

DEPENDENT ON ANOTHER

RETURN, ENTER “0”

Number of other dependents

FOR YOUR REGULAR

EXEMPTION.

Yourself

Spouse

Age 65 or Over? (Please see instructions)

Please Round to Nearest Whole Dollar

Begin Here to arrive at Oklahoma Adjusted Gross Income. Lines 1-19: In the Federal column, enter the amounts from your Federal Tax Return.

See the instructions to igure the amounts to report in the Oklahoma column.

		Federal Amount			Oklahoma Amount
1	Wages, salaries, tips, etc		00	1	00
2	Taxable interest income		00	2	00
3	Dividend income		00	3	00
4	Taxable refunds (state income tax)		00	4	00
5	Alimony received		00	5	00
6	Business income or (loss) (Federal Schedule C)		00	6	00
7	Capital gains or losses (Federal Schedule D)		00	7	00
8	Other gains or losses (Federal Form 4797)		00	8	00
9	Taxable IRA distribution		00	9	00
10	Taxable pensions and annuities		00	10	00
11	Rental real estate, royalties, partnerships, etc		00	11	00
12	Farm income or (loss)		00	12	00
13	Unemployment compensation		00	13	00
14	Taxable Social Security beneits (also enter on line 2 of Sch. 511NR-B)		00	14	00
			00		00
15	Other income (identify: ________________________________)		00	15	00
16	..................................................................Add lines 1 through 15		00	16		00
17	Total Federal adjustments to income (identify: ______________)		00	17	00
18	Oklahoma source income (line 16 minus line 17)			18		00
19	............Federal adjusted gross income (line 16 minus line 17)		00	19
20	Oklahoma additions: Schedule 511NR-A, line 8		00	20		00
21	..Add lines (Federal 19 and 20) and then (Oklahoma 18 and 20)		00	21		00
			00
22	Oklahoma subtractions: Schedule 511NR-B, line 15		00	22		00
23	.........Adjusted gross income: Okla. Source (line 21 minus line 22)			23		00
24	Adjusted gross income: All Sources (line 21 minus line 22) Also enter on line 25		00	24

#1695#

2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 2

Name(s) shown		Your Social
on Form 511NR:		Security Number:

Oklahoma	25	Adjusted gross income: All Sources (from page 1, line 24)		25
Standard	26	Oklahoma Adjustments (Schedule 511NR-C, line 8)		26
Deduction:	27	Income after adjustments (line 25 minus line 26)		27
• Single or	28	Oklahoma standard or Federal itemized deductions	28	00
Married Filing	29	....Exemptions ($1,000 x number of exemptions claimed on page 1)	29	00
Separate:	30		29	00
Separate:		Total deductions and exemptions (add lines 28-29)
$5,950		Total deductions and exemptions (add lines 28-29)		30
• Married	31	Oklahoma Taxable Income: (line 27 minus line 30)		31
Filing Joint	32	Oklahoma Income Tax from Tax Table		32
or Qualifying		If using Farm Income Averaging, enter tax from Form 573, line 22 and enter a “1” in box.
Widow(er):		If paying the Health Savings Account additional 10% tax, add additional tax here and enter a “2” in box.

$11,900 STOP AND READ: If line 24 is equal to or larger than line 19, complete line 33. If line 24 is smaller than line 19, see Schedule 511NR-D.

• Head of	33	Oklahoma child care/child tax credit (see instructions)			33
Household:	34	Subtract line 33 from line 32 (This is your tax base)(Do not enter less than zero)....			34
$8,700	35	Tax percentage: Oklahoma Amount (from line 23)	•	Federal Amount (from line 24)
Itemized		a)	•	b)	35
Itemized	36	Oklahoma Income Tax. Multiply line 34 by line 35		................................................	36
Deductions:	37	Credit for taxes paid to another state (enclose Form 511TX) nonresidents do not qualify 37
Enclose a	37
Enclose a
copy of the	38	Form 511CR - Other Credits Form - List 511CR line number claimed here:			38
Federal				(Do not enter less than zero) ..39
Schedule	39	Line 36 minus lines 37 and 38		(Do not enter less than zero) ..39

40Use tax due on Internet, mail order, or other out-of-state purchases while living in Oklahoma .40

If you certify that no use tax is due, place an ‘X’ here:

If iling an	41	Business Activity Tax (enclose Form 511-BAT)		41
AMENDED	42	Balance (add lines 39, 40 and 41)
return,				42
		Oklahoma withholding (enclose W-2s, 1099s or withholding statement). 43		00
complete	43
worksheet	44	2012 Oklahoma estimated tax payments	44
on page 4 of		If you are a qualiied farmer, place an ‘X’ here:		00
Form 511NR.	45	2012 payment with extension	45	00

	46	Oklahoma earned income credit (Sch. 511NR-E, line 4)	...46		00
	47	......................................................Total payments and credits (add lines 43-46)		47
For further	48	If line 47 is more than line 42, subtract line 42 from line 47. This is your overpayment .48
information	49	Amount of line 48 to be applied to 2013 estimated tax	49		00

regarding
estimated tax,	50	Donations from your refund (Sch. 511NR-F, line 20)	..50		00
see page 4 of	51	Total deductions from refund (add lines 49 and 50)		51
511NR Packet.	52	Amount to be refunded (line 48 minus line 51)		52

Direct Deposit Note:

For Direct Deposit Information see the 511NR Packet. If you do not have your refund deposited directly into your bank account, you will receive a debit card. For debit card information see “All About Refunds” in the 511NR Packet.

Is this refund going to or through an account that is located outside of the United States?			Yes	No
Deposit my refund in my:		Routing
Deposit my refund in my:
	checking account

		Number:
	savings account	Account
		Account
		Number:

53 If line 42 is more than line 47, subtract line 47 from line 42. This is your tax due ... 53 00

........54 Donation: Eastern Red Cedar Revolving Fund	$2	$5	$________ 54	00
				00


55	Donation: Public School Classroom Support Fund ..	$2	$5	$________ 55
56	Underpayment of estimated tax interest (annualized installment method				) . 56

57For delinquent payment (add penalty of 5% plus interest at 1.25% per month).57

Total tax, donation, penalty and interest (add lines 53-57) ................................58 58

Under penalty of perjury, I declare the information contained in this document, and all	Place an ‘X’ in this box if the Oklahoma Tax Commission
attachments and schedules, is true and correct to the best of my knowledge and belief.	may discuss this return with your tax preparer

Taxpayer’s signature	Date	Spouses’s signature	Date	Paid Preparer’s signature	Date
Taxpayer’s occupation		Spouse’s occupation		Paid Preparer’s address and phone number
Taxpayer’s occupation		Spouse’s occupation
Daytime Phone Number (optional)		A COPY OF FEDERAL RETURN
Daytime Phone Number (optional)
		MUST BE PROVIDED.		Paid Preparer’s PTIN

Please remit to: Oklahoma Tax Commission, P.O. Box 26800, Oklahoma City, OK 73126-0800

#1695#

2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 3 NOTE: Enclose this page ONLY if you have an amount shown on a schedule.

Name(s) shown				Your Social
on Form 511NR:				Security Number:

		Oklahoma Additions	qualiications and required enclosures.
Schedule 511NR-A			See instructions for details on

		federal amount				oklahoma amount
1	State and municipal bond interest		00		1	00
2	Lump sum distributions (not included in your Federal AGI)		00		2	00
3	Federal net operating loss		00		3	00
4	Recapture depletion claimed on a lease bonus or
	add back of excess Federal depletion		00		4	00
5	Expenses incurred to provide Okla. child care programs..		00		5	00

6Recapture of contributions to Oklahoma 529 College

	Savings Plan and OklahomaDream 529 Account(s)						00	6		00
7	Miscellaneous: Other additions		.........................................
	(enter number in box for the type of addition			)			00	7		00
8	Total additions	.................................................................					00			00
8	Total additions
	(add lines 1-7, enter total here and on line 20 of Form 511NR)							8

			Oklahoma Subtractions qualiications and required enclosures.
Schedule 511NR-B						See instructions for details on
Schedule 511NR-B
					federal amount				oklahoma amount
1	Interest on U.S. government obligations						00	1		00
2	...........Taxable Social Security (from Form 511NR, line 14)						00	2		00
3	Federal civil service retirement in lieu of social security			....			00	3		00
	- Retirement	Taxpayer Number	Spouse Number
	Claim Number:

4	Military Retirement (see instructions for limitation)						00	4		00
5	Oklahoma government or Federal civil service retirement						00	5		00
6	Other retirement income						00	6		00
7	U.S. Railroad Retirement Board Beneits						00	7		00
8	Additional depletion						00	8		00
9	Oklahoma net operating loss						00	9		00
10	Exempt tribal income						00	10		00
11	Gains from the sale of exempt government obligations			....			00	11		00
12	........................Nonresident military wages (enclose W-2)						00	12
13	Oklahoma Capital Gain Deduction (Enclose Form 561NR) ..						00	13		00
14	Miscellaneous: Other subtractions
	(enter number in box for the type of deduction			)			00	14		00
15	......................................................................Total subtractions						00 15			00
15
	(add lines 1-14, enter total here and on line 22 of Form 511NR)

			Oklahoma Adjustments qualiications and required enclosures.
Schedule 511NR-C						See instructions for details on
1	Military pay exclusion - Active Duty, Reserve and National Guard (not retirement)							1		00
1								1		00
2	Qualifying disability deduction (residents and part-year residents only)							2		00
2								2		00
3	Political contribution (limited to $100 [$200 for joint return])							3		00
4	Interest qualifying for exclusion (limited to $100 [$200 for joint return])							4		00
5	Qualiied adoption expense							5		00
6	Contributions to Oklahoma 529 College Savings Plan and OklahomaDream 529 Account(s)						.....	6		00
7	Miscellaneous: Other adjustments (enter number in box for the type of deduction						)..	7		00
8	Total Adjustments (add lines 1-7, enter total here and on line 26 of Form 511NR)							8		00
										00

#1695#

2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 4 NOTE: Enclose this page ONLY if you have an amount shown on a schedule.

Name(s) shown	Your Social
on Form 511NR:	Security Number:

Schedule 511NR-D Child Care/Child Tax Credit See instructions for details on qualiications and required enclosures.

If your Federal Adjusted Gross Income is $100,000 or less and you are allowed either a credit for child care expenses or the child tax

credit on your Federal return, then as a resident, part-year resident or nonresident military, you are allowed a credit against your Okla- homa tax. Your Oklahoma credit is the greater of:

•20% of the credit for child care expenses allowed by the IRS Code.

Your allowed Federal credit cannot exceed the amount of your Federal tax reported on your Federal return. or

•5% of the child tax credit allowed by the IRS Code.

This includes both the nonrefundable child tax credit and the refundable additional child tax credit.

The credit must be prorated based on the ratio of Oklahoma Adjusted Gross Income to Federal Adjusted Gross Income. If your Federal Adjusted Gross Income is greater than $100,000, no credit is allowed.

Enclose a copy of your Federal return and, if applicable, the Federal child care credit schedule.

1	..............................Enter your Federal child care credit	1	00
2	Multiply line 1 by 20%	2		00
3	Enter your Federal child tax credit		00
	(total of child tax credit & additional child tax credit)	3	00
	(total of child tax credit & additional child tax credit)	3
4	Multiply line 3 by 5%	4		00
5	Enter the larger of line 2 or line 4		5
5	Enter the larger of line 2 or line 4		5		00

6Divide the amount on line 24 of Form 511NR by the amount on line 19 of Form 511NR

•

Enter the percentage from the above calculation here (do not enter more than 100%)	6	%
7 Multiply line 5 by line 6. This is your Oklahoma child care/child tax credit.			00

Enter total here and on Form 511NR, line 33	7

Schedule 511NR-E Earned Income Credit See instructions for details on qualiications and required enclosures.

Residents and part-year residents are allowed a credit equal to 5% of the Earned Income Credit allowed on the Federal return. The credit must be prorated on the ratio of Oklahoma source AGI to Federal AGI. Enclose a copy of your Federal return.

Nonresidents do not qualify.

1	Federal earned income credit	1
2	Multiply line 1 by 5%	2
3	Divide the amount on line 23 of Form 511NR by the amount on line 19 of Form 511NR
	•
	•
	Enter the percentage from the above calculation here (do not enter more than 100%)	3
4	Oklahoma earned income credit	4
	(multiply line 2 by line 3, enter total here and on line 46 of Form 511NR)

00 00

% 00

Worksheet for Amended Returns Only (Form 511NR, Page 2, Line 43)

When amending Form 511NR you must adjust Form 511NR, line 43 (Oklahoma Income Tax Withheld) by subtracting any previous overpayments or adding any tax previously paid. Use worksheet below.

1.Oklahoma income tax withheld

2.Amount paid with the original return plus additional paid after it was iled

(Do not include payments of underpayment of estimated tax interest)

3.Add lines 1 and 2

4.Overpayment, if any, shown on original return or as previously adjusted by Oklahoma

5.Subtract line 4 from line 3. Enter here and on line 43 of the amended Form 511NR

00 00

Question	Answer
Form Name	Form 511Nr
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	preparer, subtractions, barcode, Oklahoma

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