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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

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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

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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

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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

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2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 5 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-F Donations from Refund

This schedule allows you to make a donation from your refund to a variety of Oklahoma organizations. Information regarding each program, their mis- sion, how funds are utilized, and their mailing address are shown in Schedule 511NR-F Information. If you are not receiving a refund, but would like to make a donation to one of these organizations, Schedule 511NR-F Information lists the mailing address to mail your donation to the organization. If you are not receiving a refund and wish to donate to the Eastern Red Cedar Revolving Fund or the Public School Classroom Support Fund, please see line 54 or 55 of Form 511NR.

Place an ‘X’ in the box associated with the dollar amount you wish to have deducted from your refund and donated to that organization. Then carry that igure over into the column at the right. When you carry your igure back to line 50 of Form 511NR, please list the line number of the organization to

which you donated. If you donate to more than one organization, please write a “99” in the box at line 50 of Form 511NR.

1	Oklahoma Wildlife Diversity Program	$2	$5	$	...1	00
2	Low Income Health Care Fund	$2	$5	$	...2
2	Low Income Health Care Fund	$2	$5	$	...2	00
3	...Oklahoma Breast and Cervical Cancer Fund	$2	$5	$	...3	00

4Support of Programs for Volunteers to Act as Court Appointed Special Advocates

	for Abused or Neglected Children	$2	$5	$	...4	00
5	Oklahoma Pet Overpopulation Fund	$2	$5	$	...5
						00
6	Support of the Oklahoma National Guard	$2	$5	$	...6	00
7	Oklahoma Leukemia and Lymphoma Fund	$2	$5	$	...7	00
8	Support of Programs for Regional Food Banks
	in Oklahoma	$2	$5	$	...8	00
9	Support of Folds of Honor Scholarship Program	$2	$5	$	...9	00
10	Y.M.C.A. Youth and Government Program	$2	$5	$	. 10	00
11
	Multiple Sclerosis Society Fund	$2	$5	$	. 11	00
12	Support Oklahoma Honor Flights	$2	$5	$	. 12	00
13	Eastern Red Cedar Revolving Fund	$2	$5	$	. 13	00
14	Support of Domestic Violence and Sexual
							00
15	Assault Services	$2	$5	$	. 14

	Support of Volunteer Fire Departments	$2	$5	$	. 15		00
16
	Oklahoma Lupus Revolving Fund	$2	$5	$	. 16		00
17
	Oklahoma Sports Eye Safety Program	$2	$5	$	. 17		00
18
	Historic Greenwood District Music Festival Fund ..	$2	$5	$	. 18		00
19	Public School Classroom Support Fund	$2	$5	$	. 19		00
20	Total donations (add lines 1-19, enter total here and on line 50 of Form 511NR)				20			00

Schedule 511NR-F: Information

1- Oklahoma Wildlife Diversity Program

The Oklahoma Wildlife Diversity Program is funded primarily by con- cerned Oklahomans. All donations provide for a variety of projects, including research on Texas horned lizards and other rare wildlife, wildlife observation activities, such as statewide educational work- shops, informational brochures and posters, and management of a bat cave purchased with previous program donations. If you are not receiving a refund, you may still support Oklahoma wildlife by send- ing a donation to: Wildlife Diversity Program, 1801 North Lincoln, Oklahoma City, OK 73105.

2- Low Income Health Care Fund

Oklahomans helping each other is what the Indigent (Low Income) Health Care Fund is all about. Donations made to the fund are used to help provide medical and dental care for needy children and families. Every dollar you donate goes directly for health care costs. If you are not receiving a refund, you may contribute toward indigent health care by sending a donation to: Oklahoma Department of Hu- man Services, Revenue Processing Unit, Re: Indigent Health Care Revolving Fund, P.O. Box 248893, Oklahoma City, OK 73124.

3- Oklahoma Breast and Cervical Cancer Fund

You may donate for the beneit of breast and cervical cancer early detection, public education and research. Your donation will be placed in a fund to be used for the purpose of funding programs to increase knowledge of breast and cervical cancer risk and prevention and provide mammograms, pap tests and biopsies for low-income women. If you are not receiving a refund, you may still donate. Mail your contribution to: Oklahoma State Department of Health, Breast and Cervical Cancer Revolving Fund, 1000 NE 10th Street, Okla- homa City, OK 73152.

4- Support for Programs for Volunteers to Act as Court Appoint- ed Special Advocates for Abused or Neglected Children

You may donate from your tax refund to support programs for volun- teers to act as Court Appointed Special Advocates for abused or ne- glected children. Donations will be placed in the Income Tax Checkoff

Revolving Fund for Court Appointed Special Advocates. Monies will be expended by the Ofice of the Attorney General for the purpose of providing grants to the Oklahoma CASA Association. If you are not

receiving a refund, you may still donate. Mail your contribution to: Oklahoma CASA Association, Inc., P.O. Box 54946, Oklahoma City, OK 73154.

2012 Form 511NR - Nonresident/Part-Year Income Tax Return - Page 6 NOTE: Do NOT enclose this page with Form 511NR.

Schedule 511NR-F: Information

5- Oklahoma Pet Overpopulation Fund

You may donate from your tax refund for the beneit of the Oklahoma Pet Overpopulation Fund. Monies placed in this fund will be expended for the purpose of developing educational programs on pet overpopulation and for implementing spay/neuter efforts in this state. If you are not receiv- ing a refund, you may still donate. Mail your contribution to: Oklahoma Department of Agriculture, Food and Forestry, Animal Industry Division, 2800 North Lincoln Blvd., Oklahoma City, OK 73105.

6- Support of the Oklahoma National Guard

You have the opportunity to donate from your tax refund for the beneit of providing inancial relief to qualiied members of the Oklahoma National Guard and their families. Donations will be placed in the Income Tax

Checkoff Revolving Fund for the Support of the Oklahoma National Guard Relief Program. Monies, to assist Oklahoma National Guard members and their families with approved hardship expenses, will be ex- pended by the Military Department. If you are not receiving a refund, you may still donate. Please mail your contribution to: Operation Homefront Task Force, 3501 Military Circle, Oklahoma City, OK 73111-4398.

7- Oklahoma Leukemia and Lymphoma Fund

You have the opportunity to donate from your tax refund for the beneit of the Oklahoma Leukemia and Lymphoma Revolving Fund. Monies from the fund will be used by the State Department of Health for the purpose of

supporting voluntary health agencies dedicated to curing Leukemia, Lym- phoma, Hodgkin’s Disease, and Myeloma and to improving the quality of life of patients and their families. If you are not receiving a refund, you

may still donate. Please mail your contribution to: State Department of Health, Oklahoma Leukemia and Lymphoma Revolving Fund - 228, P.O. Box 268823, Oklahoma City, OK 73152-8823.

8- Support of Programs for Regional Food Banks in Oklahoma

You may donate from your tax refund for the beneit of the Regional Food Bank of Oklahoma and the Community Food Bank of Eastern Oklahoma (Oklahoma Food Banks). The Oklahoma Food Banks are the largest hunger-relief organizations in the state - distributing food to charitable and faith-based feeding programs throughout all 77 counties in Oklahoma. Your donation will be used to help provide food to the more than 500,000 Oklahomans at risk of hunger on a daily basis. If you are not receiving a refund, you may still donate by mailing your contribution to: Oklahoma Department of Human Services, Revenue Processing Unit, Re: Programs for OK Food Banks, P.O. Box 248893, Oklahoma City, OK 73124.

9- Support of Folds of Honor Scholarship Program

You have the opportunity to donate from your tax refund to support the Folds of Honor Foundation. Folds of Honor is a 501(c)(3) charitable orga- nization that provides post-secondary educational scholarships for chil- dren and spouses of military service men and women killed or disabled while serving in the war in Iraq or Afghanistan. If you are not receiving

a refund, you may still donate. Mail your contribution to: Folds of Honor Foundation, 5800 North Patriot Drive, Owasso, OK 74055.

10- Y.M.C.A. Youth and Government Program

You have the opportunity to donate from your tax refund for the beneit of the Oklahoma chapter of the Y.M.C.A. Youth and Government program. Monies donated will be expended by the State Department of Education for the purpose of providing grants to the Program so young people may be educated regarding government and the legislative process. If you are not receiving a refund, you may still donate. Mail your contribution to:

Oklahoma State Department of Education, Y.M.C.A. Youth and Govern- ment Program, Ofice of the Comptroller, 2500 North Lincoln Boulevard, Room 415, Oklahoma City, OK 73105-4599.

11- Multiple Sclerosis Society Fund

You may donate for the beneit of research toward a cure for Multiple Sclerosis. Your donation will be placed in a fund for the purpose of provid- ing grants to the Multiple Sclerosis Society for purposes of mobilizing people and resources to drive research for a cure and to address the challenges of everyone affected by multiple sclerosis. If you are not receiving a refund, you may still donate. Mail your contribution to: Okla- homa State Department of Health, Multiple Sclerosis Society Revolving Fund, P.O. Box 268823, Oklahoma City, OK 73126-8823.

12- Support Oklahoma Honor Flights

You have the opportunity to donate any amount of your tax refund to sup-

port Oklahoma Honor Flights. Oklahoma Honor Flights is a 501(c)(3) not- for-proit organization that transports Oklahoma World War II veterans to

Washington, D.C. to visit the memorial dedicated to honor their service and sacriice. If you are not receiving a refund, you may still donate. Mail your contribution to: Oklahoma Honor Flights, P.O. Box 10492, Midwest

City, OK 73140.

13- Eastern Red Cedar Revolving Fund

Help stimulate rural development, improve public health and enhance wildlife habitat by donating to the Eastern Red Cedar Revolving Fund. The Fund was established to promote the harvesting and utilization of eastern red cedar trees and to promote the marketing, research and edu- cation efforts concerning the tree and eastern red cedar products. Monies donated may be expended by the State Board of Agriculture as directed by the Eastern Red Cedar Registry Board. You can also mail a contribu- tion to: Eastern Red Cedar Revolving Fund, Oklahoma Department of Agriculture, Food and Forestry, 2800 North Lincoln Boulevard, Oklahoma City, OK 73105.

14- Support of Domestic Violence and Sexual Assault Services

You may donate from your tax refund for the beneit of domestic violence and sexual assault services in Oklahoma that have been certiied by

the Attorney General. Your donation will be used to provide grants to domestic violence and sexual assault service providers for the purpose of providing domestic violence and sexual assault services in Oklahoma. The term “services” includes but is not limited to programs, shelters or a combination thereof. If you are not receiving a refund, you may still donate. Mail your contribution to: Attorney General, Domestic Violence and Sexual Assault Services Fund, 313 NE 21st Street, Oklahoma City, OK 73105.

15- Support of Volunteer Fire Departments

You may donate from your tax refund for the beneit of volunteer ire

departments in Oklahoma. Your donation will be used to provide grants to volunteer ire departments in this state for the purpose of purchasing bun- ker gear, wildland gear and other protective clothing. If you are not receiv-

ing a refund, you may still donate. Mail your contribution to: Oklahoma

State Fire Marshal, Attn: Volunteer Fire Department Fund, 2401 NW 23rd Street, Suite 4, Oklahoma City, OK 73107.

16- Oklahoma Lupus Revolving Fund

You may donate from your refund for the beneit of the Oklahoma Lupus

Revolving Fund. Monies from the fund will be used by the State Depart- ment of Health to provide grants to the Oklahoma Medical Research Foundation for the purpose of funding research into treating and curing lupus in this state. If you are not receiving a refund, you may still donate. Mail your contribution to: State Department of Health, Lupus Revolving Fund, P.O. Box 268823, Oklahoma City, OK 73152-8823.

17- Oklahoma Sports Eye Safety Program

You may donate from your refund for the beneit of the Oklahoma Sports Eye Safety Program. Your donation will be used by the State Department of Health to establish a sports eye safety grant program for the purchase and distribution of sports eye safety programs and materials to Okla- homa classrooms and sports eye safety protective wear to children age

18 and under. Monies will also be used to explore opportunities to utilize nonproit organizations to provide such safety information or equipment. If you are not receiving a refund, you may still donate. Mail your contribu-

tion to: State Department of Health, Sports Eye Safety Fund, P.O. Box 268823, Oklahoma City, OK 73152-8823.

18 - Historic Greenwood District Music Festival Fund

With part of your tax refund you can support music festivals in the Historic Greenwood District of Tulsa. Your donation will be used by the Oklahoma

Historical Society to assist with music education, public concerts, and a celebration of Tulsa’s and Oklahoma’s musical heritage. You may also mail your contributions to: Greenwood District Music Festival Fund, Okla-

homa Historical Society, 800 Nazih Zuhdi Dr., Oklahoma City, OK 73105.

19 - Public School Classroom Support Fund

Donations to the Public School Classroom Support Revolving Fund will be used by the State Board of Education to provide one or more grants annually to public school classroom teachers. Grants will be used by the classroom teacher for supplies, materials, or equipment for the class or classes taught by the teacher. Grant applications will be considered on a

statewide competitive basis. You may also mail a donation to: Oklahoma

State Board of Education, Public School Classroom Support Fund, Ofice of the Comptroller, 2500 North Lincoln Boulevard, Room 415, Oklahoma City, OK 73105-4599.

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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