Form Or-19 - Report Of Nonresident Owner Tax Withheld/tpv-19 - Payment Of Tax Withheld For Nonresidents
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1Report of Nonresident Owner Tax Withheld
Tax Year
Form
OR-19
Tax year end date of partnership, S corporation, LLC, or LLP: ______________
PART A—Entity information
PART B—Nonresident owner information
Name of partnership, S corporation, LLC, or LLP
Name
Federal employer identification number (FEIN)
Social Security number (SSN) or FEIN of owner
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Type of pass-through entity
Type of taxpayer
Taxpayer tax year end
Partnership
S corporation
LLC
LLP
Other: _________________
Individual
C corporation
PART C—Nonresident owner’s Oregon taxable income and withholding (see instructions)
(1) Percent of ownership in Part A entity
(2) Nonresident owner’s share of Oregon-source distributive income
(3) Total Oregon tax withheld
TAXPAYER’S COPY
Payment of withholding tax
Claim as Nonresident Withholding on the Oregon tax return
Payment Amount
Tax year:
Date paid:
$
Taxpayer name
SSN or business identification number (BIN)
Spouse’s/RDP’s name (if applicable)
Spouse’s/RDP’s SSN or FEIN
Current mailing address
City
State
ZIP code
150-101-182 (Rev. 08-09)
Send Form OR-19 to the nonresident owner.
Send voucher TPV-19 or a schedule and the payment to: Oregon Department of Revenue
P.O. Box 14950
Salem OR 97309-0950
Keep the above portion with your records. Do not mail it to the department.
Detach Here
Detach Here
PAYMENT OF TAX WITHHELD
FORM
For Tax Year
Department of Revenue Use Only
TPV-19
FOR NONRESIDENTS
•
150-101-182 (Rev. 09-10)
or Fiscal Year Ending
Taxpayer
Individual
Estate
(100)
(101)
Corporate excise
Trust
is:
(200)
(102)
Corporate income
(202)
Enter Payment Amount
Taxpayer name
SSN/BIN/FEIN
$
0 0
.
Spouse’s/RDP’s name (if applicable)
Secondary tax I.D. number
Current mailing address
City
State
ZIP code
PTE contact name
PTE name or PTE FEIN/BIN
Telephone number
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