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5 Oregon Department of Revenue 5
2023 Form OR-LTD
6 Lane County Mass Transit District Self-employment Tax 6
7 7
8 Page 1 of 2 • Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don’t submit photocopies or use staples. 8
9 You may file this return directly with us through Revenue Online, at www.oregon.gov/dor. 9
10 Fiscal year beginning (MM/DD/YYYY) Fiscal year ending (MM/DD/YYYY) 10
11 11
12 99/99/9999/ / 99/99/9999/ / 12
13 13
14 See instructions for checkboxes (check all that apply) 14
15 15
16 X Amended return X Name change X Address change X An extension has been filed 16
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18 X Utility or telecommunications 18
19 19
20 Did you file Form OR-LTD for 2022? X Yes X No (if no, give reason.) XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 20
21 21
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22 22
23 First name (if filer is an individual) Initial Last name 23
24 24
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XXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
26 Partnership name (if filer is a partnership) 26
27 27
28 28
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
29 Social Security number (SSN) Federal employer identification number (FEIN) Contact phone 29
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999-99-9999 99-9999999 999-999-9999
32 Business address 32
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
35 City State ZIP code 35
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37 XXXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX - 37
38 County 38
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41 XXXXXXXXXXXXXXXXXXXXXXXXX 41
42 42
43 1. Self-employment earnings from federal Schedule SE or 43
44 Partnership Form 1065 ............................................................................1. , , 99,999,999,999.00, 0 0 44
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46 2. Apportionment percentage from Schedule OR-TSE-AP .........................2. 999.9999 % 46
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48 3. Net self-employment earnings. Multiply line 1 by line 2 ..........................3. , , 99,999,999,999.00, 0 0 48
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50 4. Less: Exclusion. Not more than $400 per taxpayer .................................4. , , 99,999,999,999.00, 0 0 50
51 51
52 5. Net earnings subject to transit district tax. Line 3 minus line 4 ...............5. , , 99,999,999,999.00, 0 0 52
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54 6. Net tax. Multiply the amount on line 5 by 0.0078 ....................................6. , , 99,999,999,999.00, 0 0 54
55 55
56 7. Prepayments ............................................................................................7. , , 99,999,999,999.00, 0 0 56
57 8. Tax to pay. If line 6 is more than line 7, you have tax to pay. 57
58 Line 6 minus line 7 .................................................................Tax to pay 8. , , 99,999,999,999.00, 0 0 58
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150-560-001
63 (Rev. 07-18-23, ver. 01) 08562301010000 63
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