Form Or-20-Ins - Oregon Insurance Excise Tax Return - 2016

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2016 Form OR‑20‑INS
Office use only
02931601010000
Page 1 of 3, 150-102-129 (Rev. 10-16)
Oregon Department of Revenue
Oregon Insurance Excise Tax Return
Submit original form—do not submit photocopy
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Fiscal year beginning
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Fiscal year ending
See instructions for checkboxes.
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New name
New address
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Extension
Form OR-37
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Amended
Federal
Form 5471
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Alternative apportionment
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Legal name
FEIN
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DBA/ABN
Attn. or c/o
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Current address
City
St
ZIP code
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Contact name
Contact phone
(
)
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Web
Complete questions A through D only if this is your first return or the answer changed during this tax year.
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A. Incorporated in (state)
B. State of commercial domicile
C. Date business activity began in Oregon
D. Business activity code
Incorporated on (date)
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E.
F.
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(1) Consolidated
(2) Consolidated
(3) Corporations included in consolidated
Protective claim
federal return
Oregon return
federal return, but not in Oregon return
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G. Enter name of parent corporation, if applicable
Enter FEIN of parent corporation, if applicable
H. Number of Oregon corporations
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I. List the tax years for which federal waivers of the statute of limitations are in effect and dates on which waivers expire
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J. List the tax years for which your federal taxable income was changed by an IRS audit or by an amended federal return filed during this tax year
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K.
L.
If first return,
New
Successor to
Withdrawn,
Dissolved, or
Merged or
If final return,
indicate
business, or
previous business
indicate
reorganized
Name of previous business
Name of merged or reorganized corporation
FEIN
FEIN
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.00
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M. If you didn’t complete Schedule OR-AP, fill in the amount of your Oregon sales ..........
M.

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