WTH 10004                          Oklahoma Withholding Payment Coupon
Revised 11-2021

Who Must File a Payment Coupon - All employers who make monthly payments and do not pay electronically.
When to File and Make A Payment - Withholding tax payments are due on or before the 20th day of the month following the payroll 
period. The Withholding Payment Coupon must be submitted with each payment by check. Additionally, you must file a quarterly 
withholding return, Form WTH-10001, at the end of each quarter (3/31; 6/30; 9/30; 12/31).
Instructions for Completing the Withholding Coupon
   A. Enter the Federal Employer Identification Number (FEIN).
   B. Enter the month and year of the payment period.
   C. Enter the date on which employees were paid.
   D. Enter the amount of Oklahoma income tax withheld from the wages for the month.
   E. Check Box E to notify us of address change. Write new address in section E.
   F.  Enter the amount of withholding tax being paid with the coupon.
Interest and Penalty for Late Payments - If a payment is postmarked after the due date, a bill for penalty and interest will be issued 
when the quarterly return posts to your account.
•  Write your FEIN on your check and mail it with your completed payment coupon.
•  Do not send cash. Do not enclose any other tax returns/correspondence. 
•  Enclose check or money order payable to: Oklahoma Tax Commission.
Mail to: Oklahoma Tax Commission
         Post Office Box 26930
         Oklahoma City, OK 73126-0930
Recent Changes Beginning with 3rd Quarter 2013
   •  All employers are required to file a WTH-10001 Oklahoma Quarterly Wage Withholding Tax Return for cumulative tax withheld 
        for each calendar quarter separately from payments. A quarterly return is due on or before the 20th day of the month following 
        each quarter.
   •  Do not send a payment with quarterly return. Payment should be sent with the correct payment coupon every month to en-
        sure accurate posting to the withholding account.
Monthly payments and quarterly returns can be easily filed electronically before or on the due date by using OkTAP located at 
oktap.tax.ok.gov.
Mandatory inclusion of Social Security and/or FEIN is required on forms filed with the Oklahoma Tax Commission (OTC) pursuant to Title 68 of the Oklahoma 
Statutes and regulations thereunder, for identification purposes, and is deemed part of the confidential files and records of the OTC.
The Oklahoma Tax Commission is not required to give actual notice of changes in any state law.

 Do not fold, staple or paper clip. Please Detach Here and Return Coupon Below.                                                Do not tear or cut below line.

          BLC  Oklahoma Withholding Payment Coupon
 A. Taxpayer FEIN                  B. Payment Period C. Date Payroll Paid D. Oklahoma Tax Withheld

                                                                                                              E. Address Change

E. ___________________________________________________
   Name
 ___________________________________________________
   Address
 ___________________________________________________                                                                         - - - - - - - - - Dollars - - - - - - - - -  - - Cents - -  
   City                      State                           ZIP
Signature:  _____________________________________    Date:  ______________                                    F. Amount Paid __________________________  .  __________
The information contained in this record and any attachments is true and correct to the best of my knowledge.               Please remit only one check per coupon.