Form 538 S – Fill Out and Use This PDF

#1695#

State of Oklahoma

Claim for Credit/Refund of Sales Tax

FORM

2

Taxpayer Social

If died in 2010 or 2011,

Instructions on reverse.

Security Number

enter date of death:

Please read carefully as

0

an incomplete form may

538 s

1

Spouse’s Social

If died in 2010 or 2011,

Security Number

enter date of death:

delay your refund.

0

Taxpayer irst name, middle initial and last name

PART 1: TAXPAYER INFORMATION

Physical address in 2010 (if different than shown in mailing address section)

Spouse’s irst 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

PART 3: GROSS INCOME: Enter taxable and nontaxable gross income and assistance received by ALL members of your household in the year 2010.

PART 4: SALES TAX CREDIT COMPUTATION (For households with gross income below allowable limits, see steps 2 and 3 on back of form.)

DIRECT DEPOSIT OPTION:

For those NOT iling a Form 511.

If you are iling a Form 511, carry the credit to Form 511, line 27.

See page 2 to see if you qualify for Direct Deposit.

Is this refund going to or through an

Deposit my refund in my:

Routing

account that is located outside of

checking account

Number:

the United States?

Account

Yes

No

savings account

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

Taxpayer’s Signature and Date

Spouse’s Signature and Date

with your tax preparer, please check here:

Preparer’s Signature and Date

Occupation

Occupation

NOTICE

•Persons who have received TANF (Temporary Assistance for Needy Families) for any month in the year of 2010 will not be eligible for the sales tax credit or refund. Your monthly TANF beneit 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, 2010 to December 31, 2010.

FORM 538-S INSTRUCTIONS

Follow the steps below to determine if you (or your spouse) are eligible to take the Sales Tax Relief/Credit.

GO Yes (File Form 538-S)

STOP No (you do not qualify to ile this form)

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 ile 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, 2010, but before this tax form was iled, 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 pur- poses. 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.

Direct Deposit for those Not Filing a Form 511:

•If you are not iling a Form 511, and you would like to have the amount shown on line 15 deposited directly into your checking or sav- ings account, please complete the “Direct Deposit Option” section. If you are iling a Form 511, you will complete the Direct Deposit section on the Form 511.

•WARNING! Due to changes in the electronic banking rules, the Oklahoma Tax Commission will no longer allow direct deposits to or through foreign inancial institutions. If you use a foreign inancial institution or have a foreign address on your income tax return, you will be issued a paper check. If you have an address with an APO or FPO you are not considered to have a foreign address; your re- fund is eligible for direct deposit.

*Deinitions for the purpose of this form:

Resident of Oklahoma is deined 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 insur- ance 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 certiication by an agency of State Government, an insurance company or a physician, or by eli- gibility to receive disability beneits under the Federal Social Security Act. A veteran certiied 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 ile 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 iled no later than April 18th. (See note at bottom of page).

If you are not required to ile an Oklahoma Income Tax Return, this form must be iled no later than June 30th. If you have withholding or made estimated payments and are iling 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 iling an income tax return, mail this completed and signed form to: Oklahoma Tax Commission, Post Ofice Box 26800, Oklahoma City, OK 73126-0800.

Note: Extensions do apply to this form. If you have been granted an extension of time in order to ile your income tax return (includ- ing the April 20th due date for electronically iled returns), ile this form with your income tax return on or before the due date granted

by the extension. Enclose a copy of the extension.