Form Sps - Severance Pay Subtraction - 2015 Page 2
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17140001020000
Small business sales and employee information
One year
Two years
Year of investment
following investment
Previous year
following investment
(actual or estimated)
(estimated)
(estimated)
Number of
employees
Yearly gross
sales
(in dollars)
$
$
$
$
PART C—Severance pay subtraction calculation worksheet
1. Enter the amount of severance pay actually invested in a qualifying small business ..... 1
00
$
$500,00 0
2. Enter $500,000 ............................................................................................................ 2
00
3. Enter the lesser of line 1 or 2 ........................................................................................ 3
00
$
4. Multiply by Oregon sales factor, if applicable ............................................................... 4
.
%
5. Subtraction amount (line 3 times line 4 or enter line 3 if no sales factor) ..................... 5
00
$
Enter the subtraction amount from line 5 on the “other subtractions” line on your Oregon tax return or Schedule OR-ASC.
Use subtraction code 349.
I have read and understand the requirements of this subtraction as outline in this form. The information provided is correct
and accurate according to my best information and belief.
Signed
Taxpayer’s signature
Date
Keep a copy of this form for your records. Include this form with your return in the year for which you are claiming the
subtraction. If filing electronically, fax this notice to 503-345-2354, labeled “Attn: Suspense,” or mail it to:
Oregon Department of Revenue
Attn: Suspense
PO Box 14999
Salem OR 97309-0990
Page 2 of 2
150-101-705 (Rev. 12-15)
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