Form 150-604-002 - Quarterly Return - 2009 Page 4
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Include your daytime phone number and BIN on your check or money order.
State of Oregon Lodging Tax Payment Voucher
For Tax Year
Date Received at Revenue
2009
150-604-002 (Rev. 3-09) Calc
Program:
525
09
1
525
12
1
Due Date:
January 31, 2010
BIN:
000000000
Is this an amended return?
Yes
Enter Payment Amount
$
Please do not change address here —Use space at top of form.
0.00
Mailing Address:
Physical Site Address:
OCR FONT FOR SCANLINE USE—NEED FOR CALC FORM—DON’T DELETE
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Parent category: Financial