Form Tm - Self-Employment Tax - 2015

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FORM
TM
08541501010000
Amended Return
Tri-County Metropolitan Transportation District
Self-Employment Tax
For office use only
2015
Date received
Payment
Mo
Day
Year
/ /
Fiscal year
beginning:
1
2
3
If you have previously
Name change
Mo
Day
Year
/ /
Fiscal year
filed a return, indicate if:
ending:
Address change
First name and initial
Last name (if an individual filing)
Social Security number (SSN)
Partnership name (if a partnership filing)
Federal employer identification number (FEIN)
Business address
City
State
ZIP code
County
Telephone
Did you file Form TM for 2014?
An extension has been filed
Yes
Utility or telecommunications
No (if No, give reason) ________________________________________________________________________
Include your payment with this return.
Round all amounts to the nearest whole dollar.
1. Self-employment earnings from federal Schedule SE or Partnership Form 1065 .....................
1
%
2. Apportionment percentage (round to 4 decimal places) ..................................................................2
3. Net self-employment earnings. Multiply line 1 by line 2 .............................................................
3
4. Less: Exclusion. Not more than $400 per taxpayer ...................................................................
4
5. Net earnings subject to transit district tax. Line 3 minus line 4 .................................................
5
6. Net tax. Multiply the amount on line 5 by 0.007237 ...................................................................
6
7. Prepayments ..............................................................................................................................
7
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
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:
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 (

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