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5 Office use only 5
Form OR-NRC-CERT
6 Page 1 of 1, 150-104-008 Oregon Department of Revenue 17550001010000 6
7 (Rev. 05-25-23, ver. 01) 7
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Annual Certification for Oregon Natural Resource Credit
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11 Submit original form—do not submit photocopy. 11
12 For use with Form OR-706 •Date mm/dd/yyyy •Date mm/dd/yyyy 12
13 Qualified use period starting 99/99/9999/ / ending 99/99/9999/ / 13
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15 As the owner of inherited natural resource property or commercial fishing business property, on which the decedent’s estate elected and 15
16 claimed the Oregon Natural Resource Credit (NRC), you’re required to complete this certification form each year to maintain your eligibility 16
17 for the NRC. If you stopped using the property for qualified natural resource or commercial fishing business use before you met the five out 17
18 of eight year requirement, see instructions to file Form OR-706-R. 18
19 Part 1—Taxpayer information 19
20 •Property owner first name •Initial •Property owner last name •Property owner SSN •Property owner phone 20
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XXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXX 999-99-9999– – ((999))999-9999–
22 •Property owner name (if not an individual) •Property owner FEIN •Property owner phone 22
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– ((999))999-9999–
24 • •Property owner current mailing address •City •State •ZIP code 24
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX
26 •Decedent first name •Initial •Decedent last name •Decedent date of death •Decedent Social Security number (SSN) 26
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XXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXX99/99/9999/ / 999-99-9999– –
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29 Part 2—Description of property (see instructions) 29
30 •A. Description of the qualifying property (include a • B. Value of qualifying property •C. NRC related to the value in •D. Enter the 30
31 copy of Schedule OR-NRC, Oregon Natural Resource on which the NRC was claimed column B. natural resource 31
32 Credit, 150-104-003). (see Schedule OR-NRC, column asset code. See 32
33 D). instructions. 33
34 1. 34
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36 XXXXXXXXXXXXXXXXXXXXXXXXXXXX2. 99,999,999,999.00.0099,999,999,999.00.00 X 36
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38 XXXXXXXXXXXXXXXXXXXXXXXXXXXX3. 99,999,999,999.00.0099,999,999,999.00.00 X 38
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40 XXXXXXXXXXXXXXXXXXXXXXXXXXXX4. 99,999,999,999.00.0099,999,999,999.00.00 X 40
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42 XXXXXXXXXXXXXXXXXXXXXXXXXXXX5. 99,999,999,999.00.00.0099,999,999,999.00.00 X 42
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44 XXXXXXXXXXXXXXXXXXXXXXXXXXXX6. 99,999,999,999.00.0099,999,999,999.00.00 X 44
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46 XXXXXXXXXXXXXXXXXXXXXXXXXXXX7. 99,999,999,999.00.0099,999,999,999.00.00 X 46
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XXXXXXXXXXXXXXXXXXXXXXXXXXXX 99,999,999,999.00.00 99,999,999,999.00.00 X
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49 8. Totals • • 49
99,999,999,999.00.0099,999,999,999.00.00
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51 Part 3—Signature 51
52 To the best of my knowledge and belief, the information contained on this form is true, correct, and complete. In accordance with Oregon 52
53 Revised Statute (ORS) 118.140, I certify all natural resource or commercial fishing business property identified in part 2, remains in 53
54 qualified use for the natural resource credit. 54
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56 Property owner signature Date 56
57 X 99/99/9999/ / 57
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59 This form is due on April 15th each year. Mail this form to: 59
60 Oregon Department of Revenue, PO Box 14110, Salem OR 97309-0910 60
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