Form Or-20-S - Oregon S Corporation Tax Return - 2016 Page 4
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2016 Schedule OR-K-1
17611601010000
Distributive Share of Income, Deductions, Credits, etc.
For individual owners of pass-through entities
Final OR-K-1
Amended OR-K-1
For calendar year 2016 or fiscal year beginning ____________________, 2016 and ending ____________________, 20_____.
Part I—Pass-through entity (PTE) information
Partnership
S corporation
PTE FEIN
PTE name
PTE address
City
State
ZIP code
Part II—Owner information
Owner’s SSN
Owner’s name
Owner’s address
City
State
ZIP code
General partner or LLC member manager
Shareholder
Limited partner or other LLC member
Oregon resident?
If no, state of legal residence
Owner’s share of profit and loss/stock ownership
If a nonresident, check the appropriate box
Form OR-OC
Form OR-19
Yes
No
Beginning
%
End
%
Form OR-19-AF
Not required
Part III—Distributive share items
(a)
(b)
(c)
PTE Oregon apportionment percentage ___________%
Federal
Oregon
Form OR-40-N
column
column
line numbers
Income (losses)
17
1
Ordinary business income (loss) ...................................
17
2
Net rental real estate income (loss) ...............................
17
3
Other net rental income (loss) .......................................
4
Guaranteed payments to partners ................................
17
8
5
Interest income ..............................................................
9
6
Ordinary/qualified dividends..........................................
17
7
Royalties ........................................................................
13
8
Net short-term capital gain (loss) ..................................
13
9
Net long-term capital gain (loss) ...................................
14
10 Net section 1231 gain (loss) ..........................................
11 Other income (loss)(include schedule) ..........................
Varies
Adjustments
17
12 IRC section 179 expense ..............................................
27
13 Other adjustments (include schedule) ...........................
Oregon additions
14 Interest on state and local gov’t bonds .........................
30
15 Other additions (include schedule) ................................
30
Oregon subtractions
33
16 U.S. government interest ..............................................
33
17 Depreciation ..................................................................
33
18 Other subtractions (include schedule) ...........................
Oregon credits
52 and 55
19 Credits (include schedule) ...........................................................................................
Payments for nonresidents
60
20 PTE owner payment from Form OR-19 .......................................................................
21 Tax paid on Form OR-OC filed on owner’s behalf .......................................................
Keep this schedule with your tax records. Don’t submit with your individual tax return, Form OR-65, or Form OR-20-S.
150-101-002 (Rev. 12-16)
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