Oklahoma Form Wc 12 PDF Details

Understanding the intricacies of workers' compensation can often seem like navigating through a complex maze, especially when it comes to specific forms like the Oklahoma WC-12. Revised in January 2014, this form serves as a vital tool for Own Risk Employers or Insurance Carriers seeking a rebate from the Multiple Injury Trust Fund (MITF) for tax purposes. It requires the applicant to provide detailed information, including the total payments made to the MITF and the requested rebate amount, which is calculated as two-thirds of the payments reported. The form emphasizes the importance of accuracy and honesty, underscoring the certification of the information under penalty of perjury by the authorized representative of the employer or carrier. Additionally, eligibility for rebates hinges on timely submission, with a notable reduction in rebate amount if applications are not filed by May 31 of each year. Moreover, the processing of rebates by the Oklahoma Tax Commission doesn't commence until after July 1, demonstrating a structured timeline that applicants must adhere to. The form also details the method of payment and requires essential banking information to facilitate the transaction, highlighting the blend of bureaucratic precision and fiscal responsibility inherent in workers' compensation processes. With this framework, the Oklahoma WC-12 form presents both an opportunity for financial recoupment and a reminder of the procedural obligations that govern the workers' compensation landscape.

QuestionAnswer
Form NameOklahoma Form Wc 12
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesOklahoma, 2007, certifies, Routing

Form Preview Example

Form WC-12

Revised 1-2014

WORKERS’ COMPENSATION

MULTIPLE INJURY TRUST FUND REBATE REQUEST

FOR TAX YEAR

Name of Own Risk Employer or Insurance Carrier:

Federal Employer’s Identiication Number:

Street Address:

City, State and Zip Code:

Bank Routing Number:

Bank Account Number:

Checking

 

 

Savings

 

 

 

1. Total Multiple Injury Trust Fund Payments:

 

 

 

 

 

2. Rebate Requested (2/3 of Amount Entered on Line 1.):

 

 

The undersigned hereby certiies, under penalty of perjury, that he/she has executed this rebate request of

his/her free and voluntary will and as the duly authorized representative of the own risk employer/carrier named above and that the information and amounts herein contained relect a true, accurate, and complete statement.

Signed (name of own risk employer/carrier)

Date:

 

 

By (signature)

 

 

 

Printed Name and Title:

Telephone Number:

 

 

Beginning January 1, 2003, the Oklahoma Tax Commission shall accept applications for rebates from all eligible parties for assessments paid pertaining to the previous calendar year. Beginning with the calendar year of 2007, if any party fails to apply for a rebate on or before May 31 of each year, the Tax Commission shall reduce the amount of the rebate in the application by ten percent (10%). No rebates shall be paid until after July 1 of each year.

MAIL TO: OKLAHOMA TAX COMMISSION

ACCOUNT MAINTENANCE DIVISION

2501 NORTH LINCOLN BLVD.

OKLAHOMA CITY, OK 73194

OFFICE USE ONLY

Veriied Rebate Amount: $ __________________________________

Supervisor Initials: _________________________________

Reviewed by: ____________________________________________

Approved by: _____________________________________

 

 

Account Maintenance Division

 

Difference in rounding

Used .666 instead of 2/3

Used .667 instead of 2/3

Used .6666 instead of 2/3

Used .6667 instead of 2/3

Used ________ instead of 2/3

 

 

 

 

 

 

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Step # 1 in filling out WC-12

2. The subsequent part is to fill out these particular blanks: Printed Name and Title, Telephone Number, Beginning January the Oklahoma, Mail To Oklahoma Tax Commission, Account Maintenance Division, North Lincoln Blvd Oklahoma City, Office Use Only, Veriied Rebate Amount Reviewed, Used instead of Used instead of, Difference in rounding Used, Supervisor Initials Approved by, and Used instead of.

Tips to fill in WC-12 part 2

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