Clear Form
2016 Form OR-10
Office use only
00401601010000
Page 1 of 1, 150-101-031 (Rev. 12-16)
Oregon Department of Revenue
Underpayment of Oregon Estimated Tax
Submit original form—do not submit photocopy.
Name
Social Security number (SSN)
–
–
Exception to paying interest
1. I am claiming an exception to the imposition of estimated payment interest because I qualified
for relief under ORS 316.573 or 316.587. Write in the exception number you are claiming here
•
and on Form OR-40, box 41a; or Form OR-40-N, box 67a; or Form OR-40-P, box 66a .........................
1
Exception no.
Part A—Figure your required annual payment
•
.00
2. 2016 tax from Form OR-40, line 31; or Form OR-40-N, line 56; or Form OR-40-P, line 55 ......................
2
3. 2016 refundable tax credit amounts you claimed on Form OR-40, line 35 and 36;
•
.00
or Form OR-40-N, line 61 and 62; or Form OR-40-P, line 60 and 61 .............................................................
3
•
.00
4. Line 2 minus line 3 ....................................................................................................................................
4
•
.00
5. Multiply line 4 by 90% (0.90) .............................................................................
5
•
.00
6. 2016 Oregon income tax withheld from income .......................................................................................
6
•
.00
7. Line 4 minus line 6. If less than $1,000, stop here! You don’t owe underpayment interest ...................
7
•
.00
8. Enter your 2015 Oregon tax after all credits (include refundable). You must have filed an Oregon return ....
8
•
.00
9. Required annual payment. Enter the smaller of line 5 or line 8 ..............................................................
9
Note: If line 6 is equal to or more than line 9, stop here! You don’t owe underpayment interest. Attach this form to your return.
Part B—Figure your required installment payment
A
B
C
D
10. Payment period
due date ....................10
April 18, 2016
June 15, 2016
Sept. 15, 2016
Jan. 17, 2017
11. Divide the amount on line 9 by four and enter the amount in each column, or if you use Worksheet OR-10-AI, enter the amounts
from line 31 of the worksheet here (see instructions), and check box 41b on Form OR-40 or 67b on Form OR-40-N or 66b on
•
.00
.00
.00
.00
Form OR-40-P ......
11
Part C—Figure your interest (
See page 3 of the instructions)
No. of
Monthly
No. of
Daily
Interest
Date
Event
Amount
Running balance
months
rate
days
rate
due
.00
.00
12.
04/18/16
Req. pmt.
.00
.00
.00
13.
04/18/16
Withhold
0.003333
0.000110
.00
.00
.00
/
/
14.
Payment
0.003333
0.000110
.00
.00
.00
/
/
15.
Payment
0.003333
0.000110
.00
.00
.00
/
/
16.
Payment
0.003333
0.000110
.00
.00
17.
06/15/16
Req. pmt.
.00
.00
.00
18.
06/15/16
Withhold
0.003333
0.000110
.00
.00
.00
/
/
19.
Payment
0.003333
0.000110
.00
.00
.00
/
/
20.
Payment
0.003333
0.000110
.00
.00
.00
/
/
21.
Payment
0.003333
0.000110
.00
.00
22.
09/15/16
Req. pmt.
.00
.00
.00
23.
09/15/16
Withhold
0.003333
0.000110
.00
.00
.00
/
/
24.
Payment
0.003333
0.000110
.00
.00
.00
/
/
25.
Payment
0.003333
0.000110
.00
.00
.00
/
/
26.
Payment
0.003333
0.000110
.00
27.
01/17/17
Rate chg.
.00
.00
28.
01/17/17
Req. pmt.
.00
.00
.00
29.
01/17/17
Withhold
0.004167
0.000137
.00
.00
.00
/
/
30.
Payment
0.004167
0.000137
.00
.00
.00
/
/
31.
Payment
0.004167
0.000137
.00
.00
.00
/
/
32.
Payment
0.004167
0.000137
33.
04/18/17
—Don’t calculate interest after April 18, 2017—
34. Total interest due. Add the amounts in the interest column. Round to the nearest whole dollar and
.00
enter here and on Form OR-40, line 41; or Form OR-40-N, line 67; or Form OR-40-P, line 66 ..................34
File this form with your 2016 Oregon individual income tax return