Form 201 Fp - Forest Products Harvest Tax Return Sample (2004) - Oregon Department Of Revenue Page 23

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Form
DEPARTMENT USE ONLY
SMALL TRACT FORESTLAND SEVERANCE TAX
Date Received
390A
WESTERN OREGON
WO
2004
12047777
Business Identifi cation Number
SAMPLE TAXPAYER
200 ANY STREET
EXAMPLE CITY OR 97301
1
2
3
4
6
7
5
Range
Town ship
•
•
Landowner
Section
Volume (MBF)
Forestry Notifi cation Number (permit)
County
N or S
E or W
50
2004-771-55024-01
STF WO
20
18S
3W
01
7
Volume Subtotal
50
150-390-003 (7-04)
(Add all entries in column 7—this page)
23
150-441-409 (Rev. 2-05)

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