APACHE CORPORATION State of Oklahoma Senate Bill 1048 and

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APACHE CORPORATION State of Oklahoma Senate Bill 1048 and Powered By Docstoc
					                                 APACHE CORPORATION
                       State of Oklahoma Senate Bill 1048 and 495
                   Certification of State of Oklahoma Residency Status

Name: _________________________________________
      (Please print)

Payee / Owner Number: _____________________


Tax I.D. Number: __________________________ (Social Security or Federal Tax I.D.)

As an individual I certify that I am an Oklahoma resident as defined in current Oklahoma Tax Commission
Rule 710:50-3-36 based on the following: (mark one)

                       Established fixed and permanent home in Oklahoma

                       Possess a valid Oklahoma Homestead Exemption

                       Family remains in Oklahoma (spouse and dependent children)

                       Possess a valid Oklahoma driver’s license

                       Intend to return to Oklahoma (spouse and dependent children residing in Oklahoma)

                       Have not abandoned my Oklahoma residence

I certify that I am either a charitable organization, resident estate, resident trust, resident corporation, or
resident partnership as defined in Title 68-2353 of the Oklahoma Income Tax Code based upon the
following: (mark one)

                       A charitable organization who has filed with the Internal Revenue Service under IRC
                       Section 501c

                       Estate of a decedent whose permanent residence at his death was in Oklahoma

                       Trust where decedents permanent residence at his death was in Oklahoma

                       Trust consisting of property of a person whose permanent residence is in Oklahoma

                       Corporation whose principal place of business is located within the State of Oklahoma

                       Partnership where each partner is an Oklahoma resident, a resident estate, a resident
                       trust, or a resident corporation.

Note: Certification of Oklahoma residency will subject other income sources to Oklahoma state
income tax. Please consult your tax advisor before signing this certification if you are unclear
about the consequences of doing so.


Signature:             ____________________________________


Date:                      ______________________




7-2001 OKSB495-1048 rev.
Please send the completed form to:



                               APACHE CORPORATION
                               ATTN: CORPORATE LAND ADMINISTRATION – ONRT
                               2000 POST OAK BLVD SUITE 100
                               HOUSTON, TX 77056-4400