Sales Tax Rebate by ckt12002

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									                                                                                                                                          F20
                         Please mail form to:
                         J. Dennis Semler
                         Tulsa County Treasurer                                         Applicant # (Office Use Only) _______________
                         ATTN: Sales Tax Rebate
                         500 S Denver Ave 3rd Fl                                                  Application for
                         Tulsa OK 74103-3840                                            2009 Vision 2025 Sales Tax Rebate
                         Telephone: 918-596-5071                                Return envelope must be postmarked by March 31, 2010.
                                                 Please Print or Type Clearly
              You must complete sections 1, 4, and 5. Complete sections 2 and 3 if applicable.

SECTION 1: Applicant Information
First Name, Middle Initial, Last Name


Street Address (Do not use a Post Office Box, business address, or general delivery.)                Apartment/Condo/Room Number


City                                                                              State              Zip


Phone (         )                                     Phone (          )                             Phone (      )
□  Home       □ Cell      □ Work        □ Fax          □ Home □ Cell □ Work □ Fax                     □ Home □ Cell        □ Work □ Fax
Email Address

SECTION 2: Dependent Information A dependent is a person who is 65 years of age or older as of
December 31, 2009, who resides in the applicant’s household, and for whom the applicant is entitled to claim a
personal exemption under and pursuant to the federal income tax laws.
First Name, Middle Initial, Last Name



SECTION 3: Mailing Address (If different from applicant address provided in Section 1 above.)
Attn or C/O



Address                                                                                              Apartment/Condo/Room Number


City                                                                               State             Zip



SECTION 4: Rebate will not be issued if no box is checked.

          To qualify, APPLICANT must meet ALL FOUR requirements listed below:
           1. I am a person 65 years of age or older as of December 31, 2009.
           2. I am the family member who contributed the greatest share of the family income.                   Only one rebate of
           3. I resided in Tulsa County for the entire year of Jan. 1 – Dec. 31, 2009.
           4. I reside at the above address.                                                                   $18.00 per household
                                                           OR                                                    may be claimed.
          To qualify, DEPENDENT must meet ALL FOUR requirements listed below:
           1. Dependent is a member of the applicant’s household.                                              Please allow 6 weeks
           2. Dependent is a person 65 years of age or older as of December 31, 2009.
           3. Dependent resided in Tulsa County for the entire year of Jan. 1 – Dec. 31, 2009.
                                                                                                                  for processing.
           4. Dependent resides at the above address.

SECTION 5: Must be signed to obtain rebate. Return envelope must be postmarked by March 31, 2010.
Applicant must sign even if dependent qualifies. Under penalty of perjury, I declare that the information
contained in this document is true and correct to the best of my knowledge and belief.

Signature of Applicant:                                                                             Date:
                                                 To Qualify

   If a rebate is claimed on more than one application for the same dependent, the county treasurer
   shall determine the person entitled to claim the rebate.
   Only one rebate per household.

                                                  To Apply

Every person desiring to make a claim for a tax rebate must submit to the county a written application
on forms to be provided by the county between January 1 and March 31 of the year following the year
for which the rebate is being sought, beginning with the year 2005.
By Mail: J. Dennis Semler                        Online: www.treasurer.tulsacounty.org
         Tulsa County Treasurer                          Click on: Vision 2025 Rebate
         ATTN: Sales Tax Rebate                          Print and fill out form
         500 S Denver Ave 3rd Fl                         Mail to address at left
         Tulsa OK 74103-3840
In Person:       You may apply at the Tulsa County Treasurer’s Office between 8:30 a.m. and 5:00 p.m.,
                 Monday through Friday excluding holidays.
                 Our office is located at 500 S. Denver Ave, 3rd Fl, Tulsa, OK.

                                                  Definitions

Dependent: A person who is 65 years of age or older as of December 31, 2009, who resides in the
           applicant’s household, and for whom the applicant is entitled to claim a personal exemption
           under and pursuant to the federal income tax laws.
Family:      One or more persons living in the same household who pool their various sources of income
             into one budget to achieve the effect of sharing the cost of providing for support of the
             group.
Household: Includes all persons who occupy a group of rooms or single room which is regarded as a
           housing unit when it is occupied as separate living quarters, and when there is either:

              1. Direct access from the outside of the building or through a common hall; or
              2. Complete kitchen facilities for the exclusive use of the occupants.
Income:      Includes all money received during the year and available to be used to provide support for
             the family or household.
Person:      An individual, but shall not include a company, partnership, joint venture, joint agreement,
             association (mutual or otherwise), corporation, estate, trust, business trust, receiver, or
             trustee appointed by state or federal court or otherwise, syndicate, the State of Oklahoma,
             any court, city, municipality, school district, or any other political subdivision of the State of
             Oklahoma or group or combination acting as a unit, in the plural or singular number.
Resident:    Any person who has resided in the corporate limits of the county for the entire calendar year
             for which the refund is applied.

                                 Questions? Please call: 918-596-5071
                                A new form must be completed each year

								
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