Clear form
FORM
TM
08541501010000
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Amended Return
Tri-County Metropolitan Transportation District
Self-Employment Tax
For office use only
2015
Date received
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Payment
Mo
Day
Year
/ /
Fiscal year
beginning:
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1
2
3
If you have previously
Name change
Mo
Day
Year
/ /
Fiscal year
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•
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filed a return, indicate if:
ending:
Address change
First name and initial
Last name (if an individual filing)
Social Security number (SSN)
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Partnership name (if a partnership filing)
Federal employer identification number (FEIN)
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Business address
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City
State
ZIP code
County
Telephone
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Did you file Form TM for 2014?
An extension has been filed
Yes
Utility or telecommunications
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No (if No, give reason) ________________________________________________________________________
Include your payment with this return.
Round all amounts to the nearest whole dollar.
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1. Self-employment earnings from federal Schedule SE or Partnership Form 1065 .....................
1
%
2. Apportionment percentage (round to 4 decimal places) ..................................................................2
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3. Net self-employment earnings. Multiply line 1 by line 2 .............................................................
3
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4. Less: Exclusion. Not more than $400 per taxpayer ...................................................................
4
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5. Net earnings subject to transit district tax. Line 3 minus line 4 .................................................
5
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6. Net tax. Multiply the amount on line 5 by 0.007237 ...................................................................
6
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7. Prepayments ..............................................................................................................................
7
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8. TAX TO PAY. Is line 6 more than line 7? If so, line 6 minus line 7 ........................TAX TO PAY
8
9. Penalty and interest for filing or paying late .....................................................................................9
10. Total amount due. Line 8 plus line 9 ............................................................................................... 10
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11. REFUND. Is line 7 more than line 6? If so, line 7 minus line 6 ................................... REFUND
11
Individuals: Include a copy of your federal Schedule SE. Business activity:
Sales
Services
Other: __________________
Partnerships: Include a schedule listing each partner’s name, Social Security number, partnership earnings, and exclusion.
Apportioning? Include a copy of TSE-AP.
Under penalty of false swearing, I declare that the information in this return and any enclosures is true, correct, and complete.
Date
Your signature
Signature of preparer other than taxpayer
/ /
X
X
Telephone
License No.
Make check or money order payable to:
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Oregon Department of Revenue
Address of preparer
Mail your return to:
TMSE, Oregon Department of Revenue
ZIP code
City
State
PO Box 14003, Salem OR 97309-2502
Do NOT attach your TM self-employment tax return to your Oregon income tax return, or any other form.
Rev. 10-15)
150-555-001 (