Form 150-604-002 - Quarterly Return - 2010 Page 4
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Include your daytime phone number and BIN on your check or money order.
Oregon Lodging Tax Payment Voucher
For Tax Year
Date received at Revenue
2010
150-604-002 (Rev. 03-10) Calc
Program:
525
12
1
Due date:
January 31, 2011
BIN:
000000000
Is this an amended return?
Yes
Payment amount
$
Please do not change address here —Use space at top of form.
Mailing address:
Physical site address:
OCR FONT FOR SCANLINE USE—NEED FOR CALC FORM—DON’T DELETE
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