Form Oa - Domestic Form - 2002
ADVERTISEMENT
1
2FORM OA – DOMESTIC - 2002
BUSINESS NAME
OREGON ANNUAL TAX REPORT
:
Business
Identification Number
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:
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:
North American Industry
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R
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:
Federal EIN
Classification System
If mailing address, name or Federal EIN is wrong, complete
“Change in Status Report” found in the instruction booklet.
Using 4th quarter totals, report the number
O
O
C
C
T
T
O
O
B
B
E
E
R
R
N
N
O
O
V
V
E
E
M
M
B
B
E
E
R
R
D
D
e
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c
c
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m
m
b
b
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r
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of workers covered for Unemployment insurance
who worked during or received pay for the
period which includes the 12th of the month.
(see instruction booklet)
Place a -0- in “subject wages” box of a program for which employer is subject, but there was no payroll this year.
UNEMPLOYMENT INSURANCE
STATE WITHHOLDING
Column A
Column B
1.
Subject wages . . . .
1. Subject wages . . .
Excess wages . . . .
2.
(Wages over $25,000 per employee)
Taxable wages . . . .
3.
(Box 1A minus Box 2A)
4.
Tax rate. . . . . .
Tax . . . . . . .
5. Tax . . . . . . .
5.
(Box 3A times Box 4A)
(Must enter tax for year)
6.
L
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s
:
O
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p
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.
6. Less: Oregon Tax prepaid
L
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:
O
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T
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p
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p
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.
7.
P
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:
U
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a
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P
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:
U
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w
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.
.
.
.
Total Tax Due . .
.
.
8. Total Tax Due. . . .
.
.
8.
(Box 5A less Box 6A plus Box 7A)
(Box 5B less Box 6B)
WORKERS’ BENEFIT FUND
Put –0- in Boxes 9 & 11 if there were no
subject hours worked in the year.
(WBF) ASSESSMENT
14. TOTAL PAYMENT DUE
9
9
.
.
Number of hours worked
Add Boxes 8A, 8B, and 13.
(whole hours only)*
Make checks payable to
.036
10.
WBF assessment rate
“Oregon Department of Revenue.”
Total assessment
Only add amounts due. Do not add credits in one program to offset
11.
(Box 9 times Box 10)
taxes owed in another program
Include payment coupon (Form OTC)
1
2
.
Less: Assessment prepaid
1
2
.
13.
Total Assessment Due
*Report only hours subject to WBF assessment. Hours do not need to equal
hours reported on Form 132.
I certify this report is true and correct and is filed under penalty of false swearing.
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Signature
X
(
)
(
)
Required
MAIL TO: OREGON DEPARTMENT OF REVENUE: PO BOX 14800, SALEM, OR 97309-0920
150-211-156 (R
. 10-02)
EV
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