Form E-2004 - Combined Report Form For Estates & Trusts

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COMBINED REPORT FORM FOR ESTATES & TRUSTS
MULTNOMAH COUNTY BUSINESS INCOME TAX
Form
PORTLAND CITY BUSINESS LICENSE
Taxable Year ____/____/____ to ____/____/____
E-2004
01/01/04
12/31/04
th
th
DUE DATE: 15
day of the 4
month following the taxable year end
Name/Address:
Account #:
b
Please
if address change:
Mailing
Location
FEIN # _________________________
Business Code __________
ESTATE AND TRUST
1. Net Income or (Loss) before distribution
_________________________
$0
Reset Form
2. Multnomah County Business Income Tax add back
_________________________
$0
3. Total lines 1 and 2
_________________________
$0
4. Other income and deductions
_________________________
$0
5. Subject Net Income (total lines 3 and 4)
_________________________
$0
Multnomah County Business Income Tax
$1
8. County Gross Income = _____________________________=
100.0000%
$1
Total Gross Income
9. County Apportioned Net Income (line 5 x line 8)
____________________
$0
10. Net Operating Loss Deduction (max 75% of line 9)
(___________________) Enter as negative sum
$0
11. Income subject to tax (line 9 minus line 10)
____________________
$0
12. Tax (line 11 x tax rate of 1.45%)
____________________
$0
13. Prepayments
(___________________) Enter as negative sum
$0
14. Penalty
____________________
$0
15. Interest
____________________
$0
$0
16. Balance Due or (Overpayment)
_____________________
17. Refund _______________ Credit ____________ To Portland Underpayment_____________
$0
$0
$0
City of Portland Business License Fee
100.0000%
$1
Portland Gross Income =
=
18.
Not Liable
$1
Total Gross Income
Portland Apportioned Net Income (line 5 x line 18)
___________________
19.
$0
Net Operating Loss Deduction (max 75% of line 19)
(__________________) Enter as negative sum
20.
$0
Income subject to fee (line 19 minus line 20)
___________________
21.
$0
Fee (line 21 x rate of 2.2%) MINIMUM $100
___________________
22.
$100
a. Application Year Adjustment Fee (see instructions)
___________________
$0
b. Temporary rate increase (line 21 X .4%--no minimum)
___________________
$0
Prepayments
(__________________) Enter as negative sum
23.
$0
Penalty
___________________
24.
$0
Interest
___________________
25.
$0
Balance Due or (Overpayment)
_____________________
$100
26.
Refund _______________Credit ____________ To Portland Underpayment_____________
$0
$0
27.
$0
28. Combined amount due with report (total lines 16 and 26)
Check # _____________
$100
th
Make check payable to City of Portland, 111 SW Columbia St, 6
Floor, Portland, OR 97201-5840.
The undersigned declares that the information given on this report is true. The undersigned is authorized to act as a representative of the filer.
Signature of Filer ___________________________________________________________ Telephone (
) _______________________
Signature of Preparer _______________________________________________________________ Date __________________________________
Preparer’s Name/Address __________________________________________________________ Telephone (
) _______________________
Bureau of Licenses (503)823-5157
FAX (503)823-5192
TDD (503)823-6868
Rev 3/15/05
Print Form

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