Form C-2004 - Combined Report Form For C-Corporations
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1COMBINED REPORT FORM FOR C-CORPORATIONS
Form
MULTNOMAH COUNTY BUSINESS INCOME TAX
PORTLAND CITY BUSINESS LICENSE
C-2004
Taxable Year ____/____/____ to ____/____/____
01/01/04
12/31/04
th
th
DUE DATE: 15
day of the 4
month following the taxable year end
Name/Address:
Account #:
FEIN # _________________________
b
Please
if address change:
Mailing
Location
Business Code ___________
Attach Oregon Tax Form 20 or 20-I pgs 1-4
CORPORATION
1. Net Income or (Loss)
_________________________
$0
2. Multnomah County Business Income Tax add back
_________________________
$0
1
3. Compensation (# of controlling shareholders ____)
_________________________
$0
4. Other additions or subtractions
_________________________
$0
5. Adjusted Net Income (total lines 1,2,3 and 4)
_________________________
$0
Reset Form
6. Compensation allowance deduction
________________________
$0
7. Subject Net Income (line 5 minus line 6)
_________________________
$0
Multnomah County Business Income Tax
8. County Gross Income = ______________________________ =______________
$1
100.0000%
Total Gross Income
$1
9. County Apportioned Net Income (line 7 x line 8)
____________________
$0
10. Net Operating Loss Deduction (max 75% of line 9)
(___________________) Enter as negative number
$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 number
$0
14. Penalty
____________________
$0
15. Interest
____________________
$0
16. Balance Due or (Overpayment)
_____________________
$0
17. Refund ____________ Credit ____________To Portland Underpayment_____________
$0
$0
$0
City of Portland Business License Fee
18. Portland Gross Income = ____________________________ =______________ If you are not liable for a Portland License
$1
100.0000%
Total Gross Income
please push "Not Liable" button:
$1
Not Liable
19. Portland Apportioned Net Income (line 7 x line 18)
____________________
$0
20. Net Operating Loss Deduction (max 75% of line 19)
(___________________) Enter as negative number
$0
21. Income subject to fee (line 19 minus line 20)
____________________
$0
22. Fee (line 21 x rate of 2.2%) MINIMUM $100
____________________
$100
a. Application Year Adjustment Fee (see instructions)
____________________
$0
b. Temporary rate increase (line 21 X 0.4% --no minimum)
____________________
$0
23. Prepayments
(___________________) Enter as negative number
$0
24. Penalty
____________________
$0
25. Interest
____________________
$0
26. Balance Due or (Overpayment)
___________________
$100
27. Refund ____________ Credit ____________To Multnomah Underpayment_____________
$0
$0
$0
28. Combined amount due with report (total lines 16 and 26)
_________________
$100
Check #__________
Make check payable to City of Portland, 111 SW Columbia St, Suite 600, 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
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