Form C-01 - Combined Report Form - 2001
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1COMBINED REPORT FORM
C-01
PORTLAND CITY BUSINESS LICENSE
MULTNOMAH COUNTY BUSINESS INCOME TAX
Taxable Year ____/____/____ to ____/____/____
Name/Address:
Account #:
Please b if address change: U Mailing U Location
FEIN # _________________________
Attach Oregon Tax Form 20 or 20-I pgs 1-4
CORPORATION
1.
Net Income or (Loss)
_________________________
2.
Multnomah County Business Income Tax add back
_________________________
3.
Compensation (# of controlling shareholders ____)
_________________________
4.
Other additions or subtractions
_________________________
5.
Adjusted Net Income (total lines 1,2,3 and 4)
_________________________
6.
Compensation allowance deduction
(________________________)
7.
Subject Net Income (line 5 minus line 6)
_________________________
Multnomah County Business Income Tax
8.
County Gross Income = ______________________________ =______________.______
Total Gross Income
9.
County Apportioned Net Income (line 7 x line 8)
____________________
10. Net Operating Loss Deduction (max 75% of line 9)
(___________________)
11. Income subject to tax (line 9 minus line 10)
____________________
12. Tax (line 11 x tax rate of 1.45%)
____________________
13. Prepayments
(___________________)
14. Penalty
____________________
15. Interest
____________________
16. Balance Due or (Overpayment)
_____________________
17. Refund _______________
or Credit ________________
City of Portland Business License Fee
18. Portland Gross Income = ____________________________ =______________.______
Total Gross Income
19. Portland Apportioned Net Income (line 7 x line 18)
____________________
20. Net Operating Loss Deduction (max 75% of line 19)
(___________________)
21. Income subject to fee (line 19 minus line 20)
____________________
22. Fee (line 21 x rate of 2.2%) MINIMUM $100
____________________
a. Application Year Adjustment Fee (see instructions)
____________________
23. Prepayments
(___________________)
24. Penalty
____________________
25. Interest
____________________
26. Balance Due or (Overpayment)
_____________________
Refund _______________
or Credit ________________
27.
28. Combined amount due with report (total lines 16 and 26)
_____________________
th
Make check payable to City of Portland, 1900 SW 4
Ave, Suite #3500, Portland, OR 97201-5350.
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 ___________________________________________________________ Email Address ______________________________
Signature of Preparer ____________________________________________________________ Date __________________________________
Preparer’s Address ____________________________________________________________Telephone (
) ________________________
Bureau of Licenses (503) 823-5157
FAX (503) 823-5192
TDD (503) 823-6868
Rev 10/01
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Parent category: Financial