Oregon Quarterly Tax Return Form For Tobacco Distributors

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REVENUE USE ONLY
Clear Form
2002
Form
Date Received
530
OREGON QUARTERLY TAX RETURN
Payment Received
FOR TOBACCO DISTRIBUTORS
Quarter
Due Date
Distributor’s License No.
Business ID No.
Program
Year
Period
Liability
1
03
530
02
1
01/01/02–03/31/02 April 30, 2002
Federal Identification No.
Quarter
Please use blue or black ink when filling out this form.
Type of business:
Corporation
Partnership
Individual
Other: ________________________
Complete Schedules 1 and 2 before filling in the Quarterly Tobacco Tax Return
1. Quarterly tobacco tax (enter amount from Schedule 1, line 7) .................. 1
2. Tax credit (enter amount from Schedule 2, line 12) ................................... 2
3. Net quarterly tax (line 1 minus line 2; not less than zero) ............................................................. 3
4. Quarterly tax discount (multiply line 3 by 0.015) ........................................................................... 4
5. Net tax due (line 3 minus line 4) ................................................................................................... 5
6. Penalty and interest (see instructions) .......................................................................................... 6
7. Total amount due (add line 5 and line 6) .................................................................................... 7
DECLARATION
I declare under the penalties for false swearing [ORS 305.990(4)] that I have examined this document and to the best of
my knowledge it is true, correct, and complete.
Signature
Social Security No.
Date
PRINT Name Signed Above
Title
Telephone No.
150-605-004 (Rev. 2-02) Web
Please read the instructions on the back

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