Fillable Form Aer - Annual Exemption Request printable pdf download

CITY OF PORTLAND

REVENUE BUREAU

LICENSE AND TAX DIVISION

ACCOUNT #

111 SW Columbia St., Suite 600

Portland, OR 97201

Phone: (503) 823-5157

Fax: (503) 823-5189

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ANNUAL EXEMPTION REQUEST

This form is for businesses that meet the exemption criteria and are not required to pay the

City of Portland Business License Tax or Multnomah County Business Income Tax.

BUSINESS NAME:

BUSINESS LOCATION ADDRESS:

Check if this is an address change

MAILING ADDRESS:

Check if this is an address change

FEIN #:

SSN #:

Tax Year Beginning:

Tax Year Ending:

EXEMPTION TYPE (check one): Exemptions are based on all business activity everywhere, not just in the

City of Portland and Multnomah County:

Business grossing less than $50,000* per year from all sources before expenses for the year listed above.

*For Multnomah County: For tax years 1999 – 2007 the gross receipts exemption amount was $25,000.

*For the City of Portland: For tax years 1999 – 2006 the gross receipts exemption amount was $25,000.

Attach the appropriate tax pages (required for verification):

Sole Proprietors: attach federal Form 1040, including Schedule C, Schedule D and/or Schedule E

Partnerships: attach federal Form 1065, including Schedule K

Corporations: attach federal Form 1120 and Oregon Form 20

S-Corporations: attach federal Form 1120-S, including Schedule K

Enter your total gross receipts everywhere: $ ________________________

Individuals whose only business activity is ownership of less than ten (10) residential units. Ownership of

a commercial rental or a combination of commercial and residential rentals is NOT exempt. Any other

business activity in addition to residential rental activity (including sale of residential rentals) voids this

exemption. Attach federal Form 1040, including Schedule E.

Other (see Business License Law 7.02.400 “EXEMPTIONS”):

This form and the supporting tax pages are due on the 15

day of the 4

month following the tax year end

(April 15 for calendar year taxfilers). If you are unable to complete this form or provide the supporting tax

pages by this due date, you should request a six-month City/County extension by filing Form EXT.

I declare that the information on this form is true, and that I am authorized to act as a representative of the filer.

Printed Name:

Date:

Signature:

Phone:

MAIL OR FAX COMPLETED FORM AND TAX PAGES TO:

City of Portland Revenue Bureau, 111 SW Columbia St., Suite 600, Portland, OR 97201-5840

Fax: (503) 823-5189

Additional information is on our website at

Form AER (revised 3/19/2010)

Form Aer - Annual Exemption Request

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