2017 Volunteer Fire Department Wildland Gear Grant

Fire Department Information

  1. Name of Fire Department:
  2. Physical Address:
  3. City:
  4. Zip Code:
  5. County:
  6. FDIN/FDID Number:
  7. Department Title: (circle one)111819
  8. Department Type: (circle one)Part PaidAll Volunteer
  9. How many volunteer firefighters does your fire department have who perform firefighting duties:
  10. What is the Rural Fire District Number that the fire department operates in: (1-11):
  11. Name of Rural Fire Coordinator:
  12. Employer Identification Number (Tax Number):
  13. DUNS Number:
  14. What is the permanent resident population of your jurisdiction/district:
  15. How many stations are in your organization:
  16. From 2012 to 2014 has the department electronically reported to NFIRS or OFIRS (circle one):Yes No
  17. From 2012 to 2016 has the department received a FEMA/DHS Assistance to Firefighters Grant for Wildland PPE (circle one): Yes No
  18. Attach a one paragraph narrative justifying financial/critical need for Wildland gear.

Contact Information

  1. Primary Contact’s Name:
  2. Phone Number:
  3. Email Address:
  1. Alternate Contact’s Name:
  2. Phone Number:
  3. Email Address:
  1. Preparer’s Name:
  2. Phone Number:
  3. Email Address:
  4. Signature: Date:

Mail application to:

Attention: Wildland PPE

Oklahoma State Fire Marshal’s Office

2401 NW 23rd Street, Suite 4

Oklahoma City, OK 73107

ATTENTION: Applications must be postmarked no later than April 01, 2017

By affixing their signature(s) to this application, the applicant(s) certify that they have read and understand the requirements in 68 O.S. 2368.23 governing award of these grants and agree the monies will be used for the conditions set forth therein and that all information contained in this application is true to the best of the applicant’s knowledge, information and belief. The Oklahoma Office of the State Fire Marshal reserves the right to modify or terminate this agreement or any subsequent agreements, and/or pursue any applicable legal action with applicant if, at a future date the Oklahoma Office of the State Fire Marshal becomes aware of material misrepresentation(s) contained in this application.

Name (type or print):______Signature:______Title:______Date:______​

Oklahoma Statutes Citationized
Title 68. Revenue and Taxation
Section 2368.23 - Tax Refund Donation - Volunteer Fire Department Revolving Fund
Cite as: 68 O.S. § 2368.23 (OSCN 2015), Returns

A. Each state individual income tax return form for tax years which begin after December 31, 2011, and each state corporate tax return form for tax years beginning after December 31, 2011, shall contain a provision to allow a donation from a tax refund for the benefit of volunteer fire departments in Oklahoma.

B. Except as otherwise provided for in this section, all monies generated pursuant to subsection A of this section shall be paid to the State Treasurer by the Oklahoma Tax Commission and placed to the credit of the Volunteer Fire Department Revolving Fund created in subsection C of this section.

C. There is hereby created in the State Treasury a revolving fund to be designated the "Volunteer Fire Department Revolving Fund" administered by the Office of the State Fire Marshal. The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of all the monies received by the Office of the State Fire Marshal pursuant to the provisions of subsection A of this section. All monies accruing to the credit of the fund are appropriated and may be budgeted and expended by the Office of the State Fire Marshal at the beginning of each fiscal year for the purpose of providing grants to volunteer fire departments in this state for the purpose of purchasing bunker gear, wildland gear and other protective clothing. Expenditures from the fund shall be made upon warrants issued by the State Treasurer against claims filed as prescribed by law with the Director of the Office of Management and Enterprise Services for approval and payment.

D. If a taxpayer makes a donation pursuant to subsection A of this section in error, such taxpayer may file a claim for a refund at any time within three (3) years from the due date of the tax return. Such claims shall be filed pursuant to the provisions of Section 2373 of this title. Prior to the apportionment set forth in this section, an amount equal to the total amount of refunds made pursuant to this subsection during any one (1) year shall be deducted from the total donations received pursuant to this section during the following year and such amount deducted shall be paid to the State Treasurer and placed to the credit of the Income Tax Withholding Refund Account.

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