Fillable Form Oc - Oregon Composite Return

Form Oc - Oregon Composite Return - 2015 Page 4

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Form

For Revenue use only

01371501040000

OC-TR

Date received

Oregon Composite Return Payment Transfer Request

Page 1

For owners not joining Form OC

Tax year

Use this form for nonresident owners who are not joining Form OC. This form is to transfer payments from the entity’s account to the accounts for the owners.

The owners must file their own returns if not joining Form OC. Use this form only if estimated payments have already been paid in the pass-through entity’s name.

Name of pass-through entity (PTE)

Federal employer identification number (FEIN)

Office use only

Street address

City

State

ZIP code

Name of contact person

Contact phone

Contact email

Check date

Estimated payments

Amount of payment

(MM/DD/YYYY)

Payment 1

.00

Payment 2

.00

Payment 3

.00

Payment 4

.00

Important—Complete page 2 of Form OC-TR before signing and mailing form.

Sign below and keep a copy of this return for your tax records.

Under penalties for false swearing, I certify that I am authorized to request transfer of estimated tax payments from the above-named pass-through entity’s tax account to the

tax accounts listed on page 2.

Signature of general partner, LLC member, or officer

Date

Signature of paid preparer

Print name of preparer

Print name of general partner, LLC member, or officer

License number or preparer

Preparer address

Title

Date

Phone

City