Form Ef - Oregon Individual Income Tax Declaration For Electronic Filing

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Clear Form
20
Oregon Individual
Form
Enter
EF
Tax
Income Tax Declaration
Year
for Electronic Filing
Do not mail this form to the
Oregon Department of Revenue
Last name
First name and initial
Social Security number (SSN)
Spouse’s/RDP’s last name if joint return
Spouse’s/RDP’s first name and initial if joint return
Spouse’s/RDP’s SSN, if joint return
Current mailing address
State
ZIP code
City
Telephone number
(
)
Part I—
Tax return information (whole dollars only)
1 NET REFUND (Form 40, Form 40N, or Form 40P) ..........................................................................................................
1
2 AMOUNT YOU OWE (Form 40, Form 40N, or Form 40P) ...............................................................................................
2
Part II—
Direct deposit of refund (see instructions)
3 Routing number
Caution:
O re g o n i s un a b l e to c ha n g e a c c o u nt
information. Please verify that your banking
4 Account number
information is correct. Entering incorrect
information will cause a delay in your refund.
5 Type of account
Checking or
Savings
Part III—
Declaration of taxpayer(s)
6a
I consent that my refund be directly deposited as designated in the electronic portion of my Oregon income tax return (Form 40,
Form 40N, or Form 40P). If I have filed a joint return, this is an irrevocable appointment of the spouse/RDP as an agent to receive the
refund.
6b
I do not want direct deposit of my refund or I am not receiving a refund.
Under penalties for false swearing, I declare that I have compared the information contained on my return with the information I have provided to
my electronic return originator (ERO) or on-line service provider (OLSP) and that the amounts described in Part I above agree with the amounts
shown on the corresponding lines of my Oregon income tax return. To the best of my knowledge and belief, my return is true, correct, and
complete. I consent that my return, including this declaration and accompanying schedules and statements, be forwarded upon request to the
Oregon Department of Revenue (DOR) by my ERO or OLSP. If the processing of my return or refund is delayed, I authorize the department to
disclose to my preparer the reason(s) for the delay, or when the refund was sent.
X
Sign
here
Your signature
Date
Spouse’s/RDP’s signature (if filing jointly, both must sign)
Date
Part IV—
Declaration of electronic return originator (ERO) or paid preparer
I declare that I have reviewed the above taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. If I
am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects data on the return. The taxpayer will
have signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with Oregon, and have followed
all other requirements described in the Legacy Electronic Filing Handbook for Software Developers and Tax Preparers, and the Modernized Electronic
Filing Handbook for Software Developers and Tax Preparers. If I am also the paid preparer, under penalties of perjury I declare that I have examined
the above taxpayer’s return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and
complete. This declaration is based on all information of which I have any knowledge.
Date
ERO’s signature
ERO’s license number
Check if paid preparer
Electronic
X
Check if self-employed
return
Firm’s name (or yours if self-employed)
Telephone number
(
)
originator’s
use only
State
ERO’s address
City
ZIP code
Under penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best
of my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.
Date
Certificate/license number
Preparer’s signature
Check if self-employed
X
Paid
Telephone number
Firm’s name (or yours if self-employed)
preparer’s
(
)
use only
Preparer’s address
City
State
ZIP code
PlEASE DO NOT MAIl ThIS FORM OR YOUR PAPER RETURN TO ThE OREgON DEPARTMENT OF REvENUE
150-101-339 (Rev. 10-11)
Form EF, page 1 of 2

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