Multnomah County Business Income Tax Form - 2003
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Revised 1/03
City of Portland Oregon
ACCOUNT #
Bureau of Licenses
111 SW Columbia St, Suite 600
Portland OR 97201-5814
Multnomah County only
Office: (503) 823-5157
FAX: (503) 823-5189
City of Portland $100 minimum
MULTNOMAH COUNTY BUSINESS INCOME TAX FORM
Multnomah County Business Income Tax is 1.45% of net business income. Apportionment may be allowed for
business activity performed outside the County. THERE IS NO MINIMUM TAX.
SOME OF THE INFORMATION PROVIDED ON THIS FORM MAY BE SUBJECT TO DISCLOSURE UNDER PUBLIC RECORD LAW
1)
NAME:
PRINT Name(s) of Owners, Partners, Corporation – as filed on the State of Oregon Tax Return
OWNERS
ALL PARTNERS
OWNERS: PLEASE LIST
OF CORPORATIONS (OWN 5% STOCK) &
ON THE BACK OF THIS FORM.
2)
BUSINESS NAME/Doing Business As (DBA): [If different from above NAME]
3) BUSINESS CODE (NAICS - see
instructions)
4)
BUSINESS CONTACT NAME:
CONTACT TITLE:
CONTACT PHONE:
(
)
Is this person authorized to represent the licensee?
Yes
No
5)
TAX ENTITY:
Sole Proprietor/1 Mbr LLC
Partnership
Corporation
Estate
Trust
Ltd. Liability Company
Ltd. Partnership
S – Corporation
Other:
(check one)
6)
FISCAL YEAR
BUSINESS FAX:
7)
TAX ENTITY ID # (Not subject to disclosure)
END:
(
)
F.E.I.N:
SS #:
8)
NUMBER OF
9)
DATE BUSINESS ACTIVITY
?
10) Is business activity performed outside Portland
Yes
No
OWNERS:
BEGAN IN PORTLAND:
(MM/DD/YY)
?
11) Is this a new business
Yes
No
IF business previously licensed, name of previous owner:
12) Email Address:
13)
PRIMARY BUSINESS ADDRESS: (location)
(List additional locations in space provided below)
Number/Street - NOT PO BOX
City, State, Zip Code
14) BUSINESS ACTIVITY DESCRIPTION:
15) BUSINESS
CODE
(NAICS)
If business activity includes rental/leasing residential or commercial property, list property addresses on back of this form
17)
PROPERTY TYPE: Is business address on:
16)
BUSINESS PHONE:
COMMERCIAL
RESIDENTIAL property?
(
)
18) MAILING ADDRESS:
(If different from line 13 above)
19) LIST ADDITIONAL BUSINESS ADDRESSES, BUSINESS NAME, & BUSINESS CODE (NAICS) AT EACH LOCATION.
Use additional sheets if necessary
LOC
BUSINESS
LOCATION ADDRESS
BUSINESS NAME AT THIS LOCATION
#
CODE/NAICS
For office use only
:
$
PAYMENT:
CASH
RECEIPT #
CHECK #:
PDX: Total $_________ Status: _____ TO: _________________ Comment:
MULT: Total $_________ Status: ______ TO: _________________ Comment:
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