Form Ltd - Self-Employment Tax - 2014
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For office use only
FORM
2014
Lane County
Date received
LTD
•
Mass Transit District
•
Payment
•
Self-Employment Tax
•
(240)
2
3
1
•
•
•
Mo
Day
Year
Mo
Day
Year
Fiscal year
/ /
/ /
If you have previously
Name change
Fiscal year
•
•
beginning:
filed a return, indicate if:
Address change
ending:
Last name (if an individual filing)
First name and initial
Social Security number (SSN)
•
•
Federal employer identification number (FEIN)
Partnership name (if a partnership filing)
Business address
Oregon business identification number (BIN)
•
City
State
ZIP code
County
Telephone number
•
An extension has been filed
Did you file Form LTD for 2013?
•
This is an amended return
Yes
Utility or telecommunications
No (if No, give reason) ________________________________________________________________________
Include your payment with this return.
Round all amounts to the nearest whole dollar.
•
1. Self-employment earnings from federal Schedule SE or Partnership Form 1065 ....................
1
2. Apportionment percentage ..............................................................................................................2
%
•
3. Net self-employment earnings. Multiply line 1 by line 2 ............................................................
3
•
4. Less: Exclusion. Not more than $400 per taxpayer ..................................................................
4
•
5. Net earnings subject to transit district tax. Line 3 minus line 4 ................................................
5
•
6. Net tax. Multiply line 5 by 0.0070 ..............................................................................................
6
•
7. Prepayments .............................................................................................................................
7
•
8. TAX TO PAY. Is line 6 more than line 7? If so, line 6 minus line 7 .........................TAX TO PAY
8
9. Penalty and interest for filing or paying late .....................................................................................9
10. Total amount due. Line 8 plus line 9. ..............................................................................................10
•
11. REFUND. Is line 7 more than line 6? If so, line 7 minus line 6 ................................... REFUND
11
Individuals: Attach a copy of your federal Schedule SE. Business activity:
Sales
Services
Other: ____________________
Partnerships: Attach a schedule listing each partner’s name, Social Security number, partnership earnings, and exclusion.
Apportioning? Attach a copy of TSE-AP.
Under penalty of false swearing, I declare that the information in
I authorize the Department of Revenue
Yes
No
this return and any attachments is true, correct, and complete.
to discuss this return with this preparer.
Date
Your signature
Signature of preparer other than taxpayer
/ /
X
X
Telephone
License No.
Make check or money order payable to:
•
Oregon Department of Revenue
Address of preparer
Mail your return to:
LTDSE, Oregon Department of Revenue
ZIP code
City
State
PO Box 14003, Salem OR 97309-2502
Do NOT attach your LTD self-employment tax return to your Oregon income tax return, or any other form.
150-560-001 (Rev. 10-14)
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