Form 201 Fp - Forest Products Harvest Tax Return Sample (2004) - Oregon Department Of Revenue Page 27

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Form
DEPARTMENT USE ONLY
SMALL TRACT FORESTLAND SEVERANCE TAX
Date Received
391A
EASTERN OREGON
EO
2004
12058888
Business Identifi cation Number
SAMPLE TAXPAYER
200 ANY STREET
EXAMPLE CITY OR 97801
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
20
2004-971-85017-01
STF-EO
31
3S
38E
01
7
Volume Subtotal
20
150-391-002 (7-04)
(Add all entries in column 7—this page)
27
150-441-409 (Rev. 2-05)

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