Form Tm - Self-Employment Tax - 2013 Page 5
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Form
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With grid & data
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For office use only
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FORM
2013
TM
Tri-County
Date received
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Metropolitan Transportation District
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Payment
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(230)
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Self-Employment Tax
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•
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X
If you have previously
Name change
Fiscal year
Fiscal year
/
/
/ /
Mo
Day
Year
Mo
Day
Year
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11
•
•
filed a return, indicate if:
beginning:
ending:
XX X X X X X X
XX X X X X X X
X
Address change
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Last name (if an individual filing)
First name and initial
Social Security number (SSN)
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•
X X X X X X X X X X X X X X X X X X X X X X X X 1 2 3 - 4 5 - 6 7 8 9
X X X X X X X X X X X X X X X X X X X X
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Partnership name (if a partnership filing)
Federal employer identification number (FEIN)
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X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
1 2 - 3 4 5 6 7 8 9
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Business address
Oregon business identification number (BIN)
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X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
1 2 3 4 5 6 7 8 - 9
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City
State
ZIP code
County
Telephone
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X X X X X X X X X X X X X X X X X X X X X X X X X
X X X X X - X X X X X X X X X X X X X X X X X X X X X - X X X - X X X X
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Did you file Form TM for 2012?
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An extension has been filed
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X
Yes
X
This is an amended return
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X
No (if No, give reason) ________________________________________________________________________
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Utility or telecommunications
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Include your payment with this return.
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X X X X X X X X X X X X X X X X
1. Self-employment earnings from federal Schedule SE or Partnership Form 1065 .....................
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%
2. Apportionment percentage ..............................................................................................................2
X X X X X X X X X X X X X X X
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3. Net self-employment earnings. Multiply line 1 by line 2 .............................................................
3
X X X X X X X X X X X X X X X X
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4. Less: Exclusion. Not more than $400 per taxpayer ...................................................................
4
X X X X X X X X X X X X X X X X
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5. Net earnings subject to transit district tax. Line 3 minus line 4 .................................................
5
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6. Net tax. Multiply the amount on line 5 by 0.007137 ...................................................................
6
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7. Prepayments ..............................................................................................................................
7
X X X X X X X X X X X X X X X X
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8. TAX TO PAY. Is line 6 more than line 7? If so, line 6 minus line 7 ........................TAX TO PAY
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X X X X X X X X X X X X X X X X
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9. Penalty and interest for filing or paying late .....................................................................................9
X X X X X X X X X X X X X X X X
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10. Total amount due. Line 8 plus line 9 ...............................................................................................10
X X X X X X X X X X X X X X X X
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11. REFUND. Is line 7 more than line 6? If so, line 7 minus line 6 .................................. REFUND
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X X X X X X X X X X X X X X X X
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Individuals: Attach a copy of your federal Schedule SE. Business activity:
Sales
Services
Other: ____________________
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Partnerships: Attach a schedule listing each partner’s name, Social Security number, partnership earnings, and exclusion.
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Apportioning? Attach a copy of TSE-AP.
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Yes
No
Under penalty of false swearing, I declare that the information in
I authorize the Department of Revenue
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X
X
this return and any attachments is true, correct, and complete.
to discuss this return with this preparer.
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Your signature
Date
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/ /
X
XX X X X X X X
SIGN
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HERE
Signature of preparer other than taxpayer
Address of preparer
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X
X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
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License No.
Telephone
City
State
ZIP code
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X X X - X X X - X X X X
X X X X X X X X X X X X X X X X X X X X X
X X
X X X X X - X X X X
X X X X X X X X X X X X X X X X
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Do NOT attach your TM self-employment tax return to your Oregon income tax return, or any other form.
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Make check or money order payable to:
Mail your return to: TMSE, Oregon Department of Revenue
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PO Box 14003, Salem OR 97309-2502
Oregon Department of Revenue
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Rev. 10-13) Draft 3 082913
150-555-001 (
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