Form 201 Fp - Forest Products Harvest Tax Return Sample (2004) - Oregon Department Of Revenue Page 13

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Form
FOREST PRODUCTS HARVEST TAX RETURN
DEPARTMENT USE ONLY
201
Date Received
•
•
FP
Payment Amount
2004
•
•
1
2
3
•
•
•
•
10065544
Business Identifi cation Number (BIN)
•
NO HARVEST – Check here, sign,
and return form.
SAMPLE TAXPAYER
•
Amended Return
200 ANY STREET
EXAMPLE CITY OR 97219
•
Another Party is Responsible
(attach copy of contract)
Do not white-out, cross-out, or change printed information on the return. Attach a separate explanation of changes.
5
6
1
2
3
4
7
8
Landowner
Town ship
Range
Sec-
•
•
Forestry Notifi cation Number (permit)
Operator
Sale Name/Contract Number
County
N or S
E or W
tion
Volume (MBF)
40
2004-711-75671-01
SUGARLOAF MTN
FOREST PRODUCTS
15
365
1W
02
40
2004-711-75672-01
SUGARLOAF MTN
FOREST PRODUCTS
17
375
1W
03
40
2004-711-75673-01
SUGARLOAF MTN
FOREST PRODUCTS
15
385
1W
02
40
2004-711-75674-01
SUGARLOAF MTN
FOREST PRODUCTS
15
385
1W
03
No Harvest
2004-711-75675-01
SUGARLOAF MTN
FOREST PRODUCTS
17
365
2W
01
40
2004-711-75676-01
SUGARLOAF MTN
FOREST PRODUCTS
15
365
2W
01
40
2004-711-75677-01
SUGARLOAF MTN
FOREST PRODUCTS
15
375
2W
01
9
Total Volume
280
Please attach a copy of any additional permit(s) that are not
•
(Total amounts from column 8 on all pages)
printed on this form.
10
25 MBF Exemption
– 25 MBF
Make check or money order payable to:
11
Taxable Volume
255
Oregon Department of Revenue
•
(Box 9 minus box 10. If less than zero, enter zero)
12
Tax
752 25
•
Mail to: Timber Tax Programs
(Multiply amount in box 11 X $2.95)
▲
Oregon De partment of Revenue
13
PO Box 14003
Estimated or Prior Payment for 2004
•
▲
Salem OR 97309-2502
14
TAX DUE WITH THIS RETURN
752 25
•
(Subtract box 13 from box 12)
▲
DECLARATION: Under penalties for false swearing, I declare that
15
Overpayment
I have examined this return, including accompanying schedules and
•
▲
statements, and to the best of my knowledge and belief it is true,
16
Up to 3 months late, enter .05 X box 14
correct, and complete.
➧
Penalty
Over 3 months late, enter .25 X box 14
▲
17
Signature(s)
Sample Taxpayer
➧
Number of days late X .000137 X box 14
Interest
X
▲
18
Telephone No.
Date
TOTAL PAYMENT
752.25
541
555-7777
January 15, 2005
(
)
(Add boxes 14, 16, and 17)
—KEEP A COPY OF THIS RETURN FOR YOUR RECORDS—
150-502-201 (Rev. 7-04)
13
150-441-409 (Rev. 2-05)

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