Multnomah County Business Income Tax Taxfilers Form Page 2

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OWNERS OF CORPORATION OR PARTNERS (List Corporate Owners that hold more than 5% of the voting stock of the
corporation – List Limited Partners, if any) Use additional sheets if necessary
NAME
ADDRESS
%
OF STOCK
ADDITIONAL BUSINESS LOCATIONS (list addresses within
ADDITIONAL ASSUMED BUSINESS NAMES:
Multnomah County) Use additional sheets if necessary
Check one
# of
ADDRESSES OF RENTAL PROPERTY OWNED: Use additional sheet(s) if necessary.
RESIDENTIAL
units
COMMERCIAL
SIGNATURE OF TAX FILER/AUTHORIZED REPRESENTATIVE
TITLE
DATE
FOR FUTHER INFORMATION CONTACT THE BUREAU OF LICENSES AT (503)823-5157

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