Oregon Combined Payroll Tax Report - 2017 Page 22
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292017 Form OR-WR
Office use only
03781701010000
Oregon Department of Revenue
Page 1 of 1, 150‑206‑012 (Rev. 12‑16)
Oregon Annual Withholding Tax Reconciliation Report
Return Due Date: January 31, 2018
Submit original form—do not submit photocopy
Business Name
Business Identification Number (BIN)
Federal Employer Identification Number (FEIN)
Number of W-2s and 1099s
Please read the instructions on the back of this report.
Use your 2017 OQ forms. See the instructions on the back.
Tax Reported
1. 1st Quarter .......................................................................................................................... 1.
2. 2nd Quarter ........................................................................................................................ 2.
3. 3rd Quarter ......................................................................................................................... 3.
4. 4th Quarter ......................................................................................................................... 4.
5. Total .................................................................................................................................. 5.
6. Total Oregon tax shown on W-2s or 1099s* ..................................................................... 6.
7. Enter the difference between box 5 and box 6 .................................................................. 7.
— If box 6 is larger than box 5, you owe tax. Pay the amount in box 7. Include a
payment coupon (Form OR-OTC) with your check.
— If box 6 is smaller than box 5, you may have a credit for the amount in box 7.
If the amount in box 7 is -0-, your withholding account balances.
Explanation of difference __________________________________________________________________________________
_________________________________________________________________________________________________________
*Include the amount of tax on your 1099s unless they are reported on a different BIN.
I certify that this report is true and correct and is fi led under penalty of false swearing.
Signature
Date
Phone
X
Name
Title
Important: Mail Form OR-WR separately from your 4th quarter Form OQ.
If no payment is
Oregon Department of Revenue
Mail Form OR-WR
Oregon Department of Revenue
included, mail
PO Box 14260
with payment to:
PO Box 14800
Salem OR 97309-5060
Salem OR 97309-0920
Form OR-WR to:
Please read the instructions on the back
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