Form Oc-V - Oregon Composite Return Payment Voucher Page 9
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Form
Oregon Composite
OC
For office use only
Return 2012
Page 1
F
B
E
T
Name of pass-through entity (PTE)
Oregon business identification number (BIN)
Street address
PO Box
Federal employer identification number (FEIN)
City
State
ZIP code
Contact e-mail
PTE contact name
Contact telephone
•
Type of PTE filing this return (check box):
If extension was filed, check here
If amending,
•
•
check here
S corporation
Partnership
LLC
Trust
LLP
Extended due date (MM/DD/YYYY)
__________________
Fiscal year end, if applicable:
Number of owners included in this composite return that are:
Individuals __________
C corporations __________
Estates _________
Trusts __________
Complete lines 1-11 on page 1 of this form for qualified electing nonresident individuals and corporate owners who are subject to
personal income or corporate income or excise tax. Complete lines 1-9 on page 2 of this form for owners of the pass-through entity
who are estates or trusts. Use blue or black ink only.
Individual
Corporate income
income tax (100)
or excise tax (204)
•
1. Tax [from Schedule OC1, line 21(e) or OC2, line 21(g)] .................................
1a
1b
2. Estimated tax paid [from Schedule OC1, line 21(f) or
•
OC2, line 21(h)] or amount paid with extension (if any) ...............................
2a
2b
•
3. Overpayment. Is line 1 less than line 2? If so, line 2 minus line 1 ...............
3a
3b
•
4. Tax to Pay. Is line 1 more than line 2? If so, line 1 minus line 2 .................
4a
4b
5. Penalty and interest. (See instructions, page 4) ............................................ 5a
5b
6. Interest on underpayment of estimated tax [Schedule OC1, line 21(g)
•
or OC2, line 21(i)] ..........................................................................................
6a
6b
7. Amount you owe. Add lines 4 through 6. This is the amount you owe ..........7a
7b
8. Balance due. Is line 7 more than line 3? If so, line 7 minus line 3 ................. 8a
8b
9. Refund. Is line 3 more than line 7? If so, line 3 minus line 7 ......................... 9a
9b
•
10. Fill in the part of line 9 you want applied to your 2013 estimated tax .......
10a
10b
11. Net refund. Line 9 minus line 10. This is your net refund .............................11a
11b
Under penalty of false swearing, I declare that the information in this return and any attachments is true, correct, and complete.
Signature of general partner, LLC member, or officer
Signature of paid preparer
License number of preparer
Sign
•
here
X
X
Keep
Date
Date
Telephone number
a copy
(
)
of this
return for
Print name of general partner, LLC member, or officer
Print name of preparer
your tax
records
Title of general partner, LLC member, or officer
Address of preparer
Make check or money order payable to: Oregon Department of Revenue
Write the pass-through entity’s FEIN or BIN and “2012 Oregon Form OC” on your payment and include voucher Form OC-V. Mail to
the “Tax to Pay” address if any columns show tax due.
Mail Refund or No Tax Due returns to:
Mail Tax to Pay returns to:
Oregon Department of Revenue
Oregon Department of Revenue
PO Box 14700
PO Box 14555
Salem OR 97309-0930
Salem OR 97309-0940
150-101-154 (Rev. 12-12)
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