Business Change In Status Form

Download a blank fillable Business Change In Status Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Business Change In Status Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Clear This Page
Oregon Combined Payroll Tax
To update business status and employment information
Business Change in Status Form
Check all boxes that apply. Attach additional sheets if needed.
Business name
BIN (Oregon business identification number)
Other names (ABN/DBA)
FEIN (Federal employer identification number)
General updates
Owner/Officer updates
(check all that apply)
New FEIN
To update owner/officer informa-
Update/Change FEIN
tion, attach a complete listing of
New business name
the current owners and officers
Update/Change business name
including position, SSN, home
Effective date
address, and phone number.
Now doing business in TriMet/Lane Transit District
/
/
Closing account
(check all that apply)
Closed pension/annuity account as of:
/
/
No longer doing business in TriMet/Lane Transit District as of:
/
/
How many employees
Business was:
Was business operating at the time
Yes
were transferred?
it was sold, leased or transferred?
Closed
Sold
No
All of business
Effective date
Date of final payroll
No longer doing
Leased
/
/
/
/
business in Oregon
Part of business
Describe what was transferred:
Transferred
New business name
New owner’s name
New owner’s telephone
Extension
(
)
New owner’s address
City
State
Zip
Where are the records of the terminated business? (Contact name, address, telephone number)
Changing entity
(check all that apply)
Effective date
Note: A new Combined Employer’s Registration form is required when there is an entity change.
/
/
Corporation —“C”
Corporation—Subchapter “S”
LLP (Limited Liability Partnership)
Change from:
Individual (Sole Proprietor)
LLC (Limited Liability Company) Recognized by IRS as:
Partnership —General
Partnership—Limited
Corporation
Sole Proprietor/Single Member
Partnership
Corporation —“C”
Corporation—Subchapter “S”
LLP (Limited Liability Partnership)
Change to:
Individual (Sole Proprietor)
LLC (Limited Liability Company) Recognized by IRS as:
Partnership —General
Partnership—Limited
Corporation
Sole Proprietor/Single Member
Partnership
Employment status updates
(check all that apply)
Still in business, but have no paid employees
. Effective date
/
/
(corporate officers are still subject to payroll taxes)
Only have workers’ compensation insurance
Only LLC members or officers
Only using independent contractors
to cover owners, officers or members.
Courtesy withholding
Employing Oregon residents in another state.
State:
Now working in Oregon.
Effective date
/
/
Using leased employees
Name of leasing company
Leasing company contact
Address
City
State
Zip
Telephone
Extension
Worker leasing company license #
(
)
Date employees leased
Number of leased employees
Total number of non-leased employees
Leasing corporate
Yes
No
officers/owners?
/
/
Submitted by:
Print name
Title
Telephone
Extension
(
)
Signature
Date
/
/
Fax to: 503-947-1700
or mail to: Employment Department, 875 Union St NE Rm 107, Salem OR 97311-0030
150-211-156 (Rev. 12-12)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go