Voluntary Tire Recycling Fee Return
Taxpayer Copy/Worksheet
Revised 5-2014
STW
20009
20009
Voluntary Tire Recycling Fee Return
STW
D. Amended
Return
Please Detach Here and Return Coupon Below
Do not fold, staple, or paper clip Do not tear or cut below line
-Office Use Only-
The information contained in this return and any attachments is true and correct to the best of my knowledge.
Signature: _________________________________ Date: _______________
1. Total number of tires to pick up .. _____________________________
2. Tires at 19
1
/2 inches or smaller
($2.50 per tire) ............................+ ___________________ . ________
3. Tires larger than 19
1
/2 inches
($3.50 per tire) ............................+ ___________________ . ________
4. Motorcycle tire fee
($1.00 per tire) ............................+ ___________________ . ________
5. Agricultural tire fee
(See instructions) .......................+ ___________________ . ________
6. Total Due Voluntary ..................= ___________________ . ________
1. Total number of tires
to pick up ........................... ___________________
2. Tires at 19
1
/2 inches or
smaller ($2.50 per tire) ... + _____________ . ____
3. Tires larger than 19
1
/2
inches ($3.50 per tire) .... + _____________ . ____
4. Motorcycle tire fee
($1.00 per tire) ................ + _____________ . ____
5. Agricultural tire fee
(See instructions) ........... + _____________ . ____
6. Total Due Voluntary ...... = _____________ . ____
- Cents - - - - - - - - Dollars - - - - - - -
Please remit only one check per coupon.
___________________________________________________
Name
___________________________________________________
Address
___________________________________________________
City State ZIP
Use this worksheet to calculate Fee, then enter the figures on the coupon below.
Instructions For Completing Voluntary Tire Recycling Fee Return
Who Must File
Persons wishing to have tire carcasses processed, but
who are not engaged in the business of selling tires; or
Tire dealers who have been engaged in selling tires
and who have collected and remitted the tire fees, as
needed, on each transaction on which a fee was due,
but who have accepted tires from Oklahoma residents
for disposal or have otherwise come into possession of
tire carcasses generated in Oklahoma, for which no fees
have been paid into the Tire Indemnity Fund.
When To File
Returns must be postmarked on or before the 20th day
of the month following each reporting period.
How to File by Paper
If ling by paper, make checks or money orders payable
to the Oklahoma Tax Commission and mail with your
return coupon to: (This address is for payments ONLY)
Oklahoma Tax Commission
Voluntary Tire Fee Remittance
Post Ofce Box 26920
Oklahoma City, OK 73126-0920
Do NOT mail correspondence to the address above.
If you must contact us in writing, include your Name and
Account Number, and mail your correspondence to:
Oklahoma Tax Commission
2501 North Lincoln Boulevard
Oklahoma City, OK 73194
Specific Item Instructions
ITEM A. (Taxpayer FEIN/SSN) – Check the box next to
the type of identication number being used, and enter
the taxpayer identication number.
ITEM B. (Reporting Period) – Enter the month(s)
and year for the Voluntary Tire Recycling Fee being
reported.
ITEM C. (Due Date) - Enter the date the return is due.
Specific Line Instructions
LINE 1. (Total Number of Tires to Pick Up) –
Enter the total number of tires to be picked up.
LINE 2. (Tires at 19
1
/2 Inches or Smaller) - Enter the
total amount of fees collected on motor vehicle tires
with a tire rim of 19
1
/2 inches or smaller. The fee per
tire is $2.50.
LINE 3. (Tires Larger than 19
1
/2 Inches) - Enter the
total amount of fees collected on motor vehicle tires
with a tire rim larger than 19
1
/2 inches. The fee per tire
is $3.50.
LINE 4. (Motorcycle Tire Fee) - Enter the total amount
of fees collected on motorcycle tires. The fee per tire
is $1.00.
LINE 5. (Agricultural Tire Fee) - Enter the total amount
of fees collected on agricultural tires that are not more
than 14 inches wide and 44 inches in diameter. The fee
for agricultural tires is $0.05 per pound (minimum $2.50
per tire).
LINE 6. (Total Due Voluntary) - Total the return; lines 2
through 5.
A.Taxpayer FEIN SSN
(check one, enter number below)
C. Due DateB. Reporting Period
A.Taxpayer FEIN SSN
(check one, enter number below)
C. Due DateB. Reporting Period
-Cents- - - - - Dollars - - - -
