Form Arts 2013 - Arts Tax Return - Arts Education & Access Fund
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1City of Portland - Revenue Bureau
Arts Tax Return - Arts Education & Access Fund
For the year Jan. 1 - Dec. 31, 2013
Due: April 15, 2014
Portland residents age 18 and older (use this form to file for income earning and non-income earning adults).
Attach sheet(s) for more than 4 residents and/or address changes.
Income earner?
First name
Middle name
Last name
Yes: $35 due
*
No income? Docs required
Phone
Same for all
Social Security # (Last 4 #s) Birth year
Email address
No: less than $1,000
*
of annual income
2013 Portland home address (e.g., 111 SW Columbia St., #600, 97201) — No PO Boxes
Same for all
No: non-taxable
*
income only
First name
Middle name
Last name
Income earner?
Yes: $35 due
*
No income? Docs required
Phone
Social Security # (Last 4 #s) Birth year
Email address
No: less than $1,000
*
of annual income
2013 Portland home address (e.g., 111 SW Columbia St., #600, 97201) — No PO Boxes
No: non-taxable
*
income only
First name
Middle name
Last name
Income earner?
Yes: $35 due
*
No income? Docs required
Phone
Social Security # (Last 4 #s) Birth year
Email address
No: less than $1,000
*
of annual income
2013 Portland home address (e.g., 111 SW Columbia St., #600, 97201) — No PO Boxes
No: non-taxable
*
income only
First name
Middle name
Last name
Income earner?
Yes: $35 due
*
No income? Docs required
Phone
Social Security # (Last 4 #s) Birth year
Email address
No: less than $1,000
*
of annual income
2013 Portland home address (e.g., 111 SW Columbia St., #600, 97201) — No PO Boxes
No: non-taxable
*
income only
Number of Portland residents (above)
Arts Tax
age 18 and older who earn income:
Total Amount Due:
Check #:
Sample amounts due: 1 person = $35; 2 people = $70; 3 people = $105; 4 people = $140
Make checks payable to “City of Portland”
I understand that if I selected “No” income it is subject to verification and that I must provide verification documents (see below)
to support the statements above. Failure to provide information to support your income claim will result in denial.
Payer name
Date
Payer daytime phone number
Payer email (if different from above)
Send this form to: Revenue Bureau Arts Tax, PO Box 1278, Portland, OR 97207 | Online:
(or )
Instructions: Important 2013 Updates
Complete this form to pay the tax. You may include all family adults on one form. If your household income is at
or below the federal poverty level, complete the Arts Tax Exemption Form (ARTX2013).
*
Income Earner - if you select a “NO” option, verification documents are required:
Select "No - less than $1,000 of income" if you individually have $0 to $999.99 income for the 2013 calendar year. Income can be from
wages, self-employment, investments, rentals, retirement (excluding Social Security, Oregon PERS and FERS), disability, unemploy-
ment, spousal/child support or any other source that the City is not prohibited from taxing. Attach Federal Form 1040 and supporting
statements (e.g., W-2s, 1099s, Schedule C, Schedule E, etc.) OR a completed 4506-T (IRS record of account) as verification.
Select "No - non-taxable income only" if you individually have income from non-taxable sources only (Social Security benefits, federal
Railroad Retirement Act benefits, Oregon PERS, FERS, CSRS or US Treasury interest) or income from non-taxable sources and less
than $1,000 of income from any other source for the 2013 calendar year. Attach Federal Form 1040 and supporting statements, plus
1099 R(s), Social Security Statement(s), and 1099INT for US Treasury interest OR a completed 4506-T (IRS record of account) to
verify non-taxable income.
ARTS2013 (2/12/2014)
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Parent category: Financial