Form Wr, Oregon Annual Withholding Tax Reconciliation Report
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12001
OREGON ANNUAL WITHHOLDING TAX
Department use only
FORM
WR
Date Received
RECONCILIATION REPORT
Business Name
Business Identification Number (BIN)
Do not send W-2s and 1099s. The Department of Revenue may request certain employers to file
W-2 or 1099 forms at a later date to reconcile their account.
Column A
Column B
Column C
Use your payment records
Additional Tax
Withholding Tax
Withholding Tax
and 2001 OQ forms. See
Due/Credit
Reported
Paid *
instructions on the back.
1. 1st Quarter
1
2. 2nd Quarter
2
3. 3rd Quarter
3
4. 4th Quarter
4
5. TOTAL
5
5
6. Total Oregon Tax shown on W-2s and/or 1099s. Include the amount
of tax on your 1099s unless you have a separate account for these
6
6
7. Difference: Subtract total in box 5B from box 6
7
7
Explanation of difference ________________________________________________________________
Explanation of difference
_____________________________________________________________________________________
_____________________________________________________________________________________
If box 6 is larger than box 5B, you owe tax. Pay the amount in box 7.
If box 6 is smaller than box 5B, you have a credit in box 7.
If the amount in box 7 is zero, your withholding account balances.
*Do not include any penalties or interest paid, only include State Withholding.
Signature
Telephone No.
Date
X
(
)
Important: Mail Form WR separately from your fourth quarter Form OQ.
Mail WR forms to:
Oregon Department of Revenue
PO Box 14260
Salem OR 97309-5060
Please read the instructions on the back
150-206-012 (Rev. 9-00)
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