Form Sp-2004 - Combined Report Form For Individuals - Multnomah County Business Income Tax

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COMBINED REPORT FORM FOR INDIVIDUALS
MULTNOMAH COUNTY BUSINESS INCOME TAX
Form
PORTLAND CITY BUSINESS LICENSE
Taxable Year ____/____/____ to ____/____/____
01/01/04
12/31/04
SP-2004
th
th
DUE DATE: 15
day of the 4
month following the taxable year end
Name/Address:
Account #:
Reset Form
b
Please
if address change:
Mailing
Location
FEIN # ________________________
Business Code ____________
SOLE PROPRIETORSHIP
, 1 MEMBER LLC
(Check one)
1. Net Income or (Loss) from Federal Schedule C
_________________________
(attach copy of Schedule C)
$0
2. Multnomah County Business Income Tax add back
_________________________
$0
3. Business Incomes from Schedule E, D, etc. (see instructions)
_________________________
$0
(attach copy of Schedule(s))
4. Total ½ SE tax and Oregon modifications
(________________________)
$0
Owners:
1
5. Adjusted Net Income (total lines 1,2,3 and 4)
_________________________
$0
6. Compensation allowance deduction (see instructions)
(________________________)
$0
7. Subject Net Income (line 5 minus line 6)
______________________
$0
Multnomah County Business Income Tax
8. County Gross Receipts =
=______
$1
100.0000%
Total Gross Receipts
$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
$0
17. Refund _______________ Credit _____________ To Portland Underpayment_____________
$0
$0
City of Portland Business License Fee
Portland Gross Receipts =
=_____
If you are not liable for the Portland Business License
18.
100.0000%
$1
please push "Not Liable" button:
Total Gross Receipts
$1
Not Liable
Portland Apportioned Net Income (line 7 x line 18)
___________________
19.
$0
Net Operating Loss Deduction (max 75% of line 19)
(__________________) Enter as negative number
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 number
23.
$0
Penalty
___________________
24.
$0
Interest
___________________
25.
$0
$100
Balance Due or (Overpayment)
_____________________
26.
Refund _______________ Credit _____________ To Multnomah Underpayment_____________
27.
$0
$0
$0
Combined amount due with report (total lines 16 and 26)
_____________________
28.
Check # ________
$100
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
Print Form
Rev. 3/15/05

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