File by Mail Instructions for your 2012 Federal Tax Return Important: Your taxes are not finished until all required steps are completed.

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1 File by Mail Instructions for your 0 Federal Tax Return Important: Your taxes are not finished until all required steps are completed. (If you prefer, you can still e-file. Go to the end of these instructions for more information.) Freida K Bailey P.O. Box Gracemont, OK 70 Balance Your federal tax return (Form 00) shows you are due a refund of Due/ $,06.. Refund What You Your tax return - The official return for mailing is included in Need to this printout. Remember to sign and date the return. Mail Attach the first copy or Copy B of Form(s) W- to the front of your Form 00. Mail your return and attachments to: Department of the Treasury Internal Revenue Service Center Fresno, CA Deadline: Postmarked by Monday, April 5, 0 Note: Your state return may be due on a different date. Please review your state filing instructions. Don't forget correct postage on the envelope. What You Keep these instructions and a copy of your return for your records. Need to If you did not print one before closing TurboTax, go back to the Keep program and select File tab, then select the Print for Your Records category. 0 Adjusted Gross Income $ 9,7. Federal Taxable Income $ 8,. Tax Total Tax $ 7,59. Return Total Payments/Credits $ 8,65. Summary Amount to be Refunded $,06. Effective Tax Rate 8.6% Changed You can still file electronically. Just go back to TurboTax, select Your Mind the File tab, then select the E-file category. We'll walk you About through the process. Once you file, we will let you know if your e-filing? return is accepted (or rejected) by the Internal Revenue Service. Page of

2 Hi Freida, We just want to thank you for using TurboTax this year! It's our goal to make your taxes easy and accurate, year after year. With TurboTax Home & Business: Your Head Start On Next Year: When you come back next year, taxes will be so easy! All your information will be saved and ready to transfer in to your new return. We'll ask you questions about what changed since we last talked, and we'll be ready to get you the credits and deductions you deserve, no matter what life throws at you. Here's the final wrap up for your 0 taxes: Your federal refund is: $,06. Your Guarantee of Accuracy: Breathe easy. The calculations on your return are backed with our % Accuracy Guarantee. - We double checked your return for errors along the way. - We helped with step-by-step guidance to get your answers on the right IRS forms. - We asked you specific questions related to your business and found all the related deductions. - We made sure you didn't miss a deduction even if something in your life changed, like a new job, new house - or more kids! Also included: - We provide the Audit Support Center free of charge, in the unlikely event you get audited. Many happy returns from TurboTax.

3 Freida K Bailey P.O. Box Gracemont OK 70 Paul R Bailey 9,56.,. -,7. 9,7. BAA REV 0/07/ TTO 9,7.

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5 SCHEDULE E (Form 00) Department of the Treasury Internal Revenue Service (99) Name(s) shown on return Supplemental Income and Loss (From rental real estate, royalties, partnerships, S corporations, estates, trusts, REMICs, etc.) Attach to Form 00, 00NR, or Form 0. Information about Schedule E and its separate instructions is at OMB No Attachment Sequence No. Your social security number Freida K Bailey Part I Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting personal property, use Schedule C or C-EZ (see instructions). If you are an individual, report farm rental income or loss from Form 85 on page, line 0. A Did you make any payments in 0 that would require you to file Form(s) 099? (see instructions) Yes No B If Yes, did you or will you file required Forms 099? Yes No a Physical address of each property (street, city, state, ZIP code) A 0 Hallock Gracemont OK 70 B C b Type of Property A B C For each rental real estate property listed Personal Use Fair Rental Days (from list below) above, report the number of fair rental and Days personal use days. Check the QJV box only if you meet the requirements to file as 60 0 a qualified joint venture. See instructions. Type of Property: Single Family Residence Multi-Family Residence Vacation/Short-Term Rental Commercial 5 Land 6 Royalties 7 Self-Rental 8 Other (describe) Income: Properties: A B C Rents received Royalties received Expenses: 5 Advertising Auto and travel (see instructions) Cleaning and maintenance Commissions Insurance Legal and other professional fees Management fees Mortgage interest paid to banks, etc. (see instructions) 8. Other interest Repairs Supplies Taxes Utilities Depreciation expense or depletion Other (list) 9 0 Total expenses. Add lines 5 through ,77. Subtract line 0 from line (rents) and/or (royalties). If result is a (loss), see instructions to find out if you must file Form ,077. Deductible rental real estate loss after limitation, if any, on Form 858 (see instructions) (,7. ) ( ) ( ) a Total of all amounts reported on line for all rental properties.... a. b Total of all amounts reported on line for all royalty properties.... b c Total of all amounts reported on line for all properties c 8. d Total of all amounts reported on line 8 for all properties d 87. e Total of all amounts reported on line 0 for all properties e,77. Income. Add positive amounts shown on line. Do not include any losses Losses. Add royalty losses from line and rental real estate losses from line. Enter total losses here 5 (,7. ) 6 Total rental real estate and royalty income or (loss). Combine lines and 5. Enter the result here. If Parts II, III, IV, and line 0 on page do not apply to you, also enter this amount on Form 00, line 7, or Form 00NR, line 8. Otherwise, include this amount in the total on line on page For Paperwork Reduction Act Notice, see your tax return instructions. BAA REV 0/0/ TTO Schedule E (Form 00) 0 A B C QJV -,7.

6 Form 797 Department of the Treasury Internal Revenue Service Sales of Business Property (Also Involuntary Conversions and Recapture Amounts Under Sections 79 and 80F(b)()) Attach to your tax return. Information about Form 797 and its separate instructions is at OMB No Attachment Sequence No. 7 Name(s) shown on return Identifying number Freida K Bailey Enter the gross proceeds from sales or exchanges reported to you for 0 on Form(s) 099-B or 099-S (or substitute statement) that you are including on line, 0, or 0 (see instructions) Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other Than Casualty or Theft Most Property Held More Than Year (see instructions) (a) Description of property (b) Date acquired (mo., day, yr.) (c) Date sold (mo., day, yr.) (d) Gross sales price (e) Depreciation allowed or allowable since acquisition (f) Cost or other basis, plus improvements and expense of sale (g) Gain or (loss) Subtract (f) from the sum of (d) and (e) Gain, if any, from Form 68, line Section gain from installment sales from Form 65, line 6 or Section gain or (loss) from like-kind exchanges from Form Gain, if any, from line, from other than casualty or theft Combine lines through 6. Enter the gain or (loss) here and on the appropriate line as follows: Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the instructions for Form 065, Schedule K, line 0, or Form 0S, Schedule K, line 9. Skip lines 8, 9,, and below. Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the amount from line 7 on line below and skip lines 8 and 9. If line 7 is a gain and you did not have any prior year section losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital gain on the Schedule D filed with your return and skip lines 8, 9,, and below. 8 Nonrecaptured net section losses from prior years (see instructions) Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line below. If line 9 is more than zero, enter the amount from line 8 on line below and enter the gain from line 9 as a long-term capital gain on the Schedule D filed with your return (see instructions) Part II Ordinary Gains and Losses (see instructions) 0 Ordinary gains and losses not included on lines through 6 (include property held year or less): Loss, if any, from line ( ) Gain, if any, from line 7 or amount from line 8, if applicable Gain, if any, from line Net gain or (loss) from Form 68, lines and 8a Ordinary gain from installment sales from Form 65, line 5 or Ordinary gain or (loss) from like-kind exchanges from Form Combine lines 0 through For all except individual returns, enter the amount from line 7 on the appropriate line of your return and skip lines a and b below. For individual returns, complete lines a and b below: a If the loss on line includes a loss from Form 68, line 5, column (b)(ii), enter that part of the loss here. Enter the part of the loss from income-producing property on Schedule A (Form 00), line 8, and the part of the loss from property used as an employee on Schedule A (Form 00), line. Identify as from Form 797, line 8a. See instructions.. 8a b Redetermine the gain or (loss) on line 7 excluding the loss, if any, on line 8a. Enter here and on Form 00, line 8b,.,.,. For Paperwork Reduction Act Notice, see separate instructions. BAA REV /8/ TTO Form 797 (0)

7 Form 797 (0) Page Part III Gain From Disposition of Property Under Sections 5, 50, 5, 5, and 55 (see instructions) 9 (a) Description of section 5, 50, 5, 5, or 55 property: A B C D (b) Date acquired (mo., day, yr.) (c) Date sold (mo., day, yr.) sold 0 Hallock 07/0/0 /0/0 These columns relate to the properties on lines 9A through 9D. 0 Gross sales price (Note: See line before completing.). 0 Cost or other basis plus expense of sale..... Depreciation (or depletion) allowed or allowable... Adjusted basis. Subtract line from line.... Property A Property B Property C Property D 5,0. 5,0.,.,667. Total gain. Subtract line from line If section 5 property: a Depreciation allowed or allowable from line... 5a b Enter the smaller of line or 5a b 6 If section 50 property: If straight line depreciation was used, enter -0- on line 6g, except for a corporation subject to section 9. a Additional depreciation after 975 (see instructions). 6a b Applicable percentage multiplied by the smaller of line or line 6a (see instructions) b c Subtract line 6a from line. If residential rental property or line is not more than line 6a, skip lines 6d and 6e 6c d Additional depreciation after 969 and before d e Enter the smaller of line 6c or 6d e f Section 9 amount (corporations only) f g Add lines 6b, 6e, and 6f g 7 If section 5 property: Skip this section if you did not dispose of farmland or if this form is being completed for a partnership (other than an electing large partnership). a Soil, water, and land clearing expenses a b Line 7a multiplied by applicable percentage (see instructions) 7b c Enter the smaller of line or 7b c 8 If section 5 property: a Intangible drilling and development costs, expenditures for development of mines and other natural deposits, mining exploration costs, and depletion (see instructions) a b Enter the smaller of line or 8a b 9 If section 55 property: a Applicable percentage of payments excluded from income under section 6 (see instructions).... 9a b Enter the smaller of line or 9a (see instructions). 9b Summary of Part III Gains. Complete property columns A through D through line 9b before going to line 0. 0 Total gains for all properties. Add property columns A through D, line Add property columns A through D, lines 5b, 6g, 7c, 8b, and 9b. Enter here and on line Subtract line from line 0. Enter the portion from casualty or theft on Form 68, line. Enter the portion from other than casualty or theft on Form 797, line Part IV Recapture Amounts Under Sections 79 and 80F(b)() When Business Use Drops to 50% or Less (see instructions) Section 79 expense deduction or depreciation allowable in prior years Recomputed depreciation (see instructions) Recapture amount. Subtract line from line. See the instructions for where to report.. 5 REV /8/ TTO,.,.,. (a) Section 79,.,. (b) Section 80F(b)() 0. Form 797 (0)

8 File by Mail Instructions for your 0 Oklahoma Tax Return Important: Your taxes are not finished until all required steps are completed. (If you prefer, you can still e-file. Go to the end of these instructions for more information.) Freida K Bailey P.O. Box Gracemont, OK 70 Balance Your Oklahoma state tax return (Form 5) shows you owe a balance due Due/ of $85.. Refund You are paying by check. What You Your tax return - The official return for mailing is included in Need to this printout. Remember to sign and date the return. Mail Your payment - Mail a check or money order for $85., payable to "Oklahoma Tax Commission". Write your Social Security number and "0 Form 5" on the check. Mail the return and check together. Enclose copies of your Form(s) W-, 099 or other withholding statements with your return. Mail your return, attachments and payment to: Oklahoma Tax Commission Income Tax -D Return P.O. Box 6905 Oklahoma City, OK Deadline: Postmarked by April 5, 0 Don't forget correct postage on the envelope. What You Keep these instructions and a copy of your return for your records. Need to If you did not print one before closing TurboTax, go back to the Keep program and select File tab, then select the Print for Your Records category. 0 Taxable Income $ 87,. Oklahoma Total Tax $,69. Tax Total Payments/Credits $,909. Return Payment Due $ 85. Summary Estimated Oklahoma Estimated Payment Vouchers for 0 - Do not mail the Payments to following vouchers (Form OW-8-ES) with your 0 income tax return. Make for Next These vouchers are used to prepay your 0 income taxes that will be Year's Return filed next year. Page of

9 File by Mail Instructions for your 0 Oklahoma Tax Return Important: Your taxes are not finished until all required steps are completed. (If you prefer, you can still e-file. Go to the end of these instructions for more information.) Freida K Bailey P.O. Box Gracemont, OK 70 Estimated Mail payments according to the schedule below: Payments to Make for Next Voucher Number Due Date Amount Year's Return 0/5/0 $ 8. (Continued) 06/7/0 $ 8. 09/6/0 $ 8. 0/5/0 $ 8. Include a separate check or money order for each payment payable to the Oklahoma Tax Commission. Write your social security number or federal employer identification number on each check. Please mail your payments to the following address: Oklahoma Tax Commission PO Box 6907 Oklahoma City OK Special Your printed state tax forms may have special formatting on them, Formatting such as bar codes or other symbols. This is to enable fast processing. Don't worry, these forms have been approved by your taxing authority and are acceptable for printing and mailing. Changed You can still file electronically. Just go back to TurboTax, select Your Mind the File tab, then select the E-file category. We'll walk you About through the process. Once you file, we will let you know if your e-filing? return is accepted (or rejected) by the state taxing agency. Page of

10 ITE 05 ITE0-7-0-IT Tax Year 0 Worksheet for Individuals See the general instructions for additional filing information Estimated total income for tax year (less income exempt by statute) Estimated deductions (standard or itemized) Exemptions ($0 for each exemption) Total deductions (add lines and ) Estimated taxable income (subtract line from line ) Estimated Oklahoma tax * Estimated Oklahoma income tax credits Estimated Oklahoma income tax liability (subtract line 7 from 6) A. Multiply line 8 by 70% B. Enter the tax liability shown on your previous year s tax return C. Enter the smaller of line 9a or 9b. This is your required annual payment to avoid underpayment interest Estimated amount of withholding Subtract line 0 from line 9c (Note: If zero or less, or line 8 minus line 0 is less than $5, stop here. You are not required to make estimated tax payments.) Amount to be paid with each voucher (if paid quarterly, / of line ) * The following applies to part-year and nonresident taxpayers who will be filing Form 5 NR. Lines through 5 shall be calculated as if all income were earned in Oklahoma. ) Using the amount from line 5, calculate the tax; this is the base tax and will be prorated for line 6. ) To calculate line 6, first estimate your income from Oklahoma sources. Divide your income from Oklahoma sources by the amount on line. ) Multiply this percentage by the base tax and enter the result on line 6. This is your estimated Oklahoma tax liability. Complete the remainder of the worksheet as directed. The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law. Do not fold, staple or paper clip Record of Estimated Tax Payments Quarter Date Paid Amount Applied from 0 Tax Return... Total Write only in white areas ITE 05 Oklahoma Individual Estimated Tax Fourth Quarter A For Tax Year B Quarter C Taxpayer s SSN OW-8-ES Revised 0-0 REV // TTO D Spouse s SSN E Address Change F Payment Due Date (for calendar year) * /5/0 FREIDA K BAILEY P.O. BOX GF Dollars Cents Amount Paid GRACEMONT OK 70 #555# Name Address City State Zip

11 ITE 05 ITE0-7-0-IT Tax Year 0 Worksheet for Individuals See the general instructions for additional filing information Estimated total income for tax year (less income exempt by statute) Estimated deductions (standard or itemized) Exemptions ($0 for each exemption) Total deductions (add lines and ) Estimated taxable income (subtract line from line ) Estimated Oklahoma tax * Estimated Oklahoma income tax credits Estimated Oklahoma income tax liability (subtract line 7 from 6) A. Multiply line 8 by 70% B. Enter the tax liability shown on your previous year s tax return C. Enter the smaller of line 9a or 9b. This is your required annual payment to avoid underpayment interest Estimated amount of withholding Subtract line 0 from line 9c (Note: If zero or less, or line 8 minus line 0 is less than $5, stop here. You are not required to make estimated tax payments.) Amount to be paid with each voucher (if paid quarterly, / of line ) * The following applies to part-year and nonresident taxpayers who will be filing Form 5 NR. Lines through 5 shall be calculated as if all income were earned in Oklahoma. ) Using the amount from line 5, calculate the tax; this is the base tax and will be prorated for line 6. ) To calculate line 6, first estimate your income from Oklahoma sources. Divide your income from Oklahoma sources by the amount on line. ) Multiply this percentage by the base tax and enter the result on line 6. This is your estimated Oklahoma tax liability. Complete the remainder of the worksheet as directed. The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law. Do not fold, staple or paper clip Record of Estimated Tax Payments Quarter Date Paid Amount Applied from 0 Tax Return... Total Write only in white areas ITE 05 Oklahoma Individual Estimated Tax Fourth Quarter A For Tax Year B Quarter C Taxpayer s SSN OW-8-ES Revised 0-0 REV // TTO D Spouse s SSN E Address Change F Payment Due Date (for calendar year) * /7/0 FREIDA K BAILEY P.O. BOX GF Dollars Cents Amount Paid GRACEMONT OK 70 #555# Name Address City State Zip

12 ITE 05 ITE0-7-0-IT Tax Year 0 Worksheet for Individuals See the general instructions for additional filing information Estimated total income for tax year (less income exempt by statute) Estimated deductions (standard or itemized) Exemptions ($0 for each exemption) Total deductions (add lines and ) Estimated taxable income (subtract line from line ) Estimated Oklahoma tax * Estimated Oklahoma income tax credits Estimated Oklahoma income tax liability (subtract line 7 from 6) A. Multiply line 8 by 70% B. Enter the tax liability shown on your previous year s tax return C. Enter the smaller of line 9a or 9b. This is your required annual payment to avoid underpayment interest Estimated amount of withholding Subtract line 0 from line 9c (Note: If zero or less, or line 8 minus line 0 is less than $5, stop here. You are not required to make estimated tax payments.) Amount to be paid with each voucher (if paid quarterly, / of line ) * The following applies to part-year and nonresident taxpayers who will be filing Form 5 NR. Lines through 5 shall be calculated as if all income were earned in Oklahoma. ) Using the amount from line 5, calculate the tax; this is the base tax and will be prorated for line 6. ) To calculate line 6, first estimate your income from Oklahoma sources. Divide your income from Oklahoma sources by the amount on line. ) Multiply this percentage by the base tax and enter the result on line 6. This is your estimated Oklahoma tax liability. Complete the remainder of the worksheet as directed. The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law. Do not fold, staple or paper clip Record of Estimated Tax Payments Quarter Date Paid Amount Applied from 0 Tax Return... Total Write only in white areas ITE 05 Oklahoma Individual Estimated Tax Fourth Quarter A For Tax Year B Quarter C Taxpayer s SSN OW-8-ES Revised 0-0 REV // TTO D Spouse s SSN E Address Change F Payment Due Date (for calendar year) * /6/0 FREIDA K BAILEY P.O. BOX GF Dollars Cents Amount Paid GRACEMONT OK 70 #555# Name Address City State Zip

13 ITE 05 ITE0-7-0-IT Tax Year 0 Worksheet for Individuals See the general instructions for additional filing information Estimated total income for tax year (less income exempt by statute) Estimated deductions (standard or itemized) Exemptions ($0 for each exemption) Total deductions (add lines and ) Estimated taxable income (subtract line from line ) Estimated Oklahoma tax * Estimated Oklahoma income tax credits Estimated Oklahoma income tax liability (subtract line 7 from 6) A. Multiply line 8 by 70% B. Enter the tax liability shown on your previous year s tax return C. Enter the smaller of line 9a or 9b. This is your required annual payment to avoid underpayment interest Estimated amount of withholding Subtract line 0 from line 9c (Note: If zero or less, or line 8 minus line 0 is less than $5, stop here. You are not required to make estimated tax payments.) Amount to be paid with each voucher (if paid quarterly, / of line ) * The following applies to part-year and nonresident taxpayers who will be filing Form 5 NR. Lines through 5 shall be calculated as if all income were earned in Oklahoma. ) Using the amount from line 5, calculate the tax; this is the base tax and will be prorated for line 6. ) To calculate line 6, first estimate your income from Oklahoma sources. Divide your income from Oklahoma sources by the amount on line. ) Multiply this percentage by the base tax and enter the result on line 6. This is your estimated Oklahoma tax liability. Complete the remainder of the worksheet as directed. The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law. Do not fold, staple or paper clip Record of Estimated Tax Payments Quarter Date Paid Amount Applied from 0 Tax Return... Total Write only in white areas ITE 05 Oklahoma Individual Estimated Tax Fourth Quarter A For Tax Year B Quarter C Taxpayer s SSN OW-8-ES Revised 0-0 REV // TTO D Spouse s SSN E Address Change F Payment Due Date (for calendar year) * /5/0 FREIDA K BAILEY P.O. BOX GF Dollars Cents Amount Paid GRACEMONT OK 70 #555# Name Address City State Zip

14 #555# Oklahoma Resident Income Tax Return Your Social Security Number Place an X in this box if this taxpayer is deceased Form 5-0 Spouse s Social Security Number (joint return only) Place an X in this box if this taxpayer is deceased Name and Address Please Print or Type Your first name, middle initial and last name FREIDA K BAILEY If a joint return, spouse s first name, middle initial and last name Mailing address (number and street, including apartment number, rural route or PO Box) P.O. BOX City, State and Zip GRACEMONT OK 70 Not Required to File Place an X in this box if you do not have sufficient gross income to require you to file a Federal return. (see instructions) Filing Status 5 Single Married filing joint return (even if only one had income) Married filing separate If spouse is also filing, PAUL R BAILEY list SSN and name in box: Head of household with qualifying person Qualifying widow(er) with dependent child Please list the year spouse died in box at right: Age 65 or Over? (Please see instructions) Yourself Spouse Exemptions * NOTE: If claiming Special Exemption, see instructions on page 7 of 5 Packet. Yourself Spouse Regular + + = Number of dependent children Number of other dependents * Special Blind = 0 = = Add the Totals from the boxes. Write the Total in the box below. Total = Note: If you may be claimed as a dependent on another return, enter 0 for your regular exemption. Part One: To Arrive at Oklahoma Adjusted Gross Income If you are not required to file, see page 5 of the 5 Packet. If line 7 is different than line, enclose a copy of your Federal return Federal adjusted gross income (from Federal 00, 00A, or 00EZ).. Oklahoma Subtractions (enclose Schedule 5-A) Line minus line Out-of-state income, except wages. Describe (a) (Enclose Federal schedule with detailed description; see instructions) Line minus line b Oklahoma Additions (enclose Schedule 5-B) Oklahoma adjusted gross income (line 5 plus line 6) Part Two: Oklahoma Taxable Income, Tax and Credits Oklahoma Standard Deduction: Single or Married Filing Separate: $5,950 Married Filing Joint or Qualifying Widow(er): $,9 Head of Household: $8,7 Itemized Deductions: Enclose copy of the Federal Schedule A. b Round to Nearest Whole Dollar Oklahoma Adjustments (enclose Schedule 5-C) Oklahoma income after adjustments (line 7 minus line 8) STOP AND READ: If line b is zero, complete lines 0-. If line b is more than zero, see Schedule 5-D and do not complete lines Oklahoma standard deduction or Federal itemized deductions Exemptions ($,0 x total number of exemptions claimed above) Total deductions and exemptions (add lines 0 and or amount from Sch. 5-D, line 5) Oklahoma Taxable Income (line 9 minus line ) Oklahoma Income Tax from Tax Table (see pages 0- of instructions) 87 If using Farm Income Averaging, enter tax from Form 57, line and enter a in box. If paying the Health Savings Account additional 0% tax, add additional tax here and enter a in box. 69 STOP AND READ: If line 7 is equal to or larger than line, complete line 5. If line 7 is smaller than line, complete Schedule 5-E. 5 Oklahoma child care/child tax credit (see instructions) Credit for taxes paid to another state (enclose Form 5TX) Form 5CR - Other Credits Form. List 5CR line number claimed here Income Tax (line minus lines 5-7) Do not enter less than zero DO NOT PAY THIS AMOUNT. PAYMENT IS FIGURED ON LINE REV // TTO

15 ... 0 Form 5 - Resident Income Tax Return - Page Name(s) shown on Form 5: FREIDA K BAILEY Security Number: Part Three: Tax, Credits and Payments 9 0 Total from line Use tax due on Internet, mail order, or other out-of-state purchases... 0 If you certify that no use tax is due, place an X here 69 Business Activity Tax (enclose Form 5-BAT)... 5 Balance (add lines 9, 0 and )... 9 Oklahoma withholding estimated tax payments (qualified farmer ) payment with extension For use tax table, see page of the 5 Packet. Enclose all W-s, 099s or other withholding statements. See back of Form 58-S or 5 Packet for further information. Low Income Property Tax Credit (enclose Form 58-H)..6 Sales Tax Relief Credit (enclose Form 58-S)... 7 Oklahoma Earned Income Credit (see instructions) (If line 7 is equal to or more than line, complete line 8. If line 7 is smaller than line, complete Schedule 5-F. If you are not required to file, see Not Required to File on page 5 of the 5 Packet for instructions)...8. Your Social 9 Total payments and credits (add lines -8)...9 Part Four: Refund 0 If line 9 is more than line, subtract line from line 9. This is your overpayment.. 0 Amount of line 0 to be applied to 0 estimated tax. For further information regarding estimated tax, see page 5 of the 5 Packet. #555# Schedule 5-G provides you with the opportunity to make a financial gift from your refund to a variety of Oklahoma organizations. Please place the line number of the organization from Schedule 5-G in the box below. If you give to more than one organization, put a 99 in the box. Enclose Schedule 5-G Donations from your refund (total from Schedule 5-G). Total deductions from refund (add lines and )... Amount to be refunded to you (line 0 minus line ) Direct Deposit Note: For Direct Deposit Information see the 5 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 5 Packet. Part Five: Amount You Owe If you have an underpayment of estimated tax (line 8) & overpayment (line 0), see instructions If line is more than line 9, subtract line 9 from line. This is your tax due...5 Donation: Eastern Red Cedar Revolving Fund... $ $5 $ 6 Donation: Public School Classroom Support Fund... $ $5 $ 7 Underpayment of estimated tax interest (annualized installment method )...8 For delinquent payment (add penalty of 5% plus interest at.5% per month). 9 Total tax, donation, penalty and interest (add lines 5-9)... 0 Under penalty of perjury, I declare the information contained in this document, and all attachments and schedules, is true and correct to the best of my knowledge and belief. Is this refund going to or through an account that is located outside of the United States? Yes No Deposit my refund in my: checking account savings account Routing Number: Account Number: Place an X in this box if the Oklahoma Tax Commission may discuss this return with your tax preparer Taxpayer s signature Date Spouse s signature Date Paid Preparer s signature Date SELF PREPARED Taxpayer s occupation Daytime Phone (optional) LOAN SPECIALIST Spouse s occupation Daytime Phone (optional) Do not staple documentation to this form. To attach items, please use a paper clip. Mailing Address for this form: P.O. Box 68, Oklahoma City, OK The Oklahoma Tax Commission is not required to give actual notice to taxpayers of changes in any state tax law. Paid Preparer s address and phone number Paid Preparer s PTIN REV // TTO

16 #555# ITI Oklahoma Business Activity Tax for Individuals Who Have A Sole Proprietorship or Report Farm Income Form 5-BAT-0 Your Social Security Number: Your first name, middle initial and last name FREIDA K BAILEY K BAILEY Mailing address (number and street, including apartment, or rural route) P.O. BOX City, State and Zip GRACEMONT OK 70 NAICS Code (This is shown in Box B of your primary Federal Schedule C/C-EZ or Schedule F) Check this box if you began doing business in Oklahoma during 0... General Information Every sole proprietor or farmer, except single-member limited liability companies (LLCs), doing business in Oklahoma is required to file a Form 5-BAT. All LLCs, including those that are disregarded entities for Federal income tax purposes, are now required to file Form BT-90. If filing a joint income tax return and both spouses are doing business in Oklahoma, complete one Form 5-BAT. If you began doing business in Oklahoma prior to January, 0 you are subject to an annual Business Activity Tax of $5. This tax will be entered on Form 5, line or Form 5NR, line. When timely paid, you are entitled to a nonrefundable income tax credit on Form 5, line 7 or Form 5NR, line 8; see Form 5CR, line for more information. All individuals complete Part. If you are not required to file an Oklahoma individual income tax return, also complete Part below. The tax is due the same date as the individual income tax return, April 5, 0. Part - Income and Deductions Total Revenue... Allowable Ordinary Trade or Business Expenses... Net Revenue (line minus line )... Round to Nearest Whole Dollar 0 NOTE: If you are filing an Oklahoma income tax return, do not complete part. Instead enclose this form with your return. The Business Activity Tax of $5 will be entered on Form 5, line or Form 5NR, line. Part - Business Activity Tax (if you are not filing an Oklahoma Individual Income Tax Return) If you are not filing an Oklahoma Individual Income Tax Return and you began your business prior to January, 0, you must pay the Business Activity Tax of $5 with this form. Enter the Business Activity Tax here... Signature: Under penalties of perjury, I declare that I have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. If prepared by person other than the taxpayer, this declaration is based on all information of which preparer has any knowledge. Your signature Date Signature of preparer Date Your printed name Printed name SELF-PREPARED Preparer s address Phone number REV // TTO