Form Aer - Annual Exemption Request Form

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FORM AER
ANNUAL EXEMPTION REQUEST FORM
REV 11/30/2016
CITY OF PORTLAND BUSINESS LICENSE TAX & MULTNOMAH COUNTY BUSINESS INCOME TAX
Mail or FAX completed form and tax pages to:
City of Portland Revenue Division
111 SW COLUMBIA, SUITE 600, PORTLAND OR 97201
Office: 503-823-5157 ~ FAX: 503-823-5189 ~ Web:
SSN OR FEIN #
TAX YEAR ENDING
BUSINESS TAX ACCOUNT #
EMAIL ADDRESS
NAME
MAILING ADDRESS
STATE/PROV
CITY
ZIP/POSTAL CODE
Check if this is an address change
OR
This is my final year in business (please also submit the Out of Business notification form)
IMPORTANT: Your exemption will not be approved without the required supporting tax pages.
1.
Exemptions are based on all business income everywhere, not just in the City of Portland and Multnomah County.
2.
Check the reason for your exemption claim below and fill in the applicable lines.
3.
Attach your supporting tax pages in order for your exemption to be verified and processed.
** Please Note: Other supporting tax pages may be requested.
Gross Receipts: Business gross income (before expenses) is less than $50,000 from all sources and locations
Sole Proprietor:
If your IRS 1040 Filing status is Married Filing Jointly, you must include all schedules for both spouses.
Attach IRS Form 1040, page 1 (Form 1040 only has net income numbers – not gross numbers)
Attach IRS Form 1040 Schedule C
See Instructions
$____________ (mark Ø if not filed)
Attach Any Additional Schedule C(s)
See Instructions
$____________ (mark Ø if not filed)
Attach IRS Form 1040 Schedule D
See instructions
$____________ (mark Ø if not filed)
Attach IRS Form 1040 Schedule E
See Instructions
$____________ (mark Ø if not filed)
Attach IRS Form 6252 & Schedule B (interest from installment sales)
$____________ (mark Ø if not filed)
Attach IRS Form 4797 (Sale of Business Property – if filed)
0.00
TOTAL
$____________
(must be less than $50,000)
Partnership:
Attach IRS Form 1065 (pages 1 – 5)
See Instructions
$____________ (mark Ø if blank)
Attach IRS Form 8825
See Instructions
$____________ (mark Ø if not filed)
0.00
TOTAL
$____________ (must be less than $50,000)
Corporation:
Attach IRS Form 1120 (pages 1 - 5)
See Instructions
$____________ (must be less than $50,000)
S-Corporation:
Attach IRS Form 1120 S (pages 1- 4)
See Instructions
$____________ (mark Ø if blank)
Attach IRS Form 8825
See Instructions
$____________ (mark Ø if not filed)
0.00
TOTAL
$____________ (must be less than $50,000)
Residential Rental: Attach IRS Form 1040 (page 1), and all Schedule E Pages
Less than 10 residential rentals for an individual is exempt for Multnomah County Business Income Tax ONLY
beginning 1/01/2012. Any other business activity, including the sale of residential rental property, voids this exemption.
Commercial rental activity or combined commercial and residential rental activity is not exempt.
Other: (see Business License Law 7.02.400 “ EXEMPTIONS” ) Please describe:
th
th
Due Date: Form and the supporting tax pages are due on the 15
day of the 4
month following the tax year end (April
15 for calendar year taxfilers). You may request a six-month extension by filing the City/County extension request form.
I declare that the information on this form is true, and that I am authorized to act as a representative of the filer.
Printed Name: _______________________________________ Date: _______________________
Signature: ___________________________________________ Telephone: __________________
FORM AER 11/30/2016
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