Form 132 - Amended Report - 2011
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1Form 132 - AMENDED Report
CLEAR FORM
BUSINESS NAME:
_
PRINT FORM
Business Identification Number:
/
QTR/YR Changed:
Correct
Original Whole
Net
Social
First
Employee Name
Correct Amount
Original Wages
Net Change
Amount of
Hours as
Change in
Security Number
Initial
Last
of Wages
as Reported
in Wages
Whole Hours
Reported
Whole Hours
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Page Totals
Page No.
of
I certify this report is true and correct and is filed under penalty of false swearing.
Prepared By
Date
Preparer Telephone Number
Signature
(
)
X
Required
FAX TO: (503) 947-1700
MAIL TO: OREGON DEPARTMENT OF REVENUE, PO BOX 14800, SALEM OR 97309-0920
OR
REV 02/11
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Parent category: Financial