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5                                                                                                           Oregon Department of Revenue                                      5
                  2023 Form OR-20-S
6                 Oregon S Corporation Tax Return                                                                                                                             6
7                                                                                                                                                                             7
8                 Page 1 of 8           • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           8
9                                                                                                                                                                             9
10          X     Excise tax                   X          Income tax                                                                                                          10
11                                                                                                                                                                            11
12          Fiscal year beginning (MM/DD/YYYY)            Fiscal year ending (MM/DD/YYYY)                                                                                     12
13                                                                                                                                                                            13
14          99/99/9999/              /                    99/99/9999/       /                                                                                                 14
15                                                                                                                                                                            15
16          See instructions for checkboxes.                                                                                                                                  16
17                                                                                                                                                                            17
18          X     New name                     X          New address         X               OR-FCG-20                X Extension                                            18
19                                                                                                                                                                            19
20          X     Form OR-37                   X          REIT/RIC            X               Amended                  X Form OR-24                                           20
21                                                                                                                                                                            21
22          X     Federal Form 8886            X          GILTI included on   X               Accounting period change X Alternative apportionment                            22
23                                                        federal return                                                 request included                                     23
24                                                                                                                                                                            24
25          Corporation legal name                                                                                                                                            25
26                                                                                                                                                                            26
27                                                                                                                                                                            27
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
28          Federal employer identification number (FEIN)                                                                                                                     28
29                                                                                                                                                                            29
30                                                                                                                                                                            30
            99-9999999
31          Doing business as (DBA) or assumed business name (ABN)                                                                                                            31
32                                                                                                                                                                            32
33                                                                                                                                                                            33
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
34          Attn: or c/o, first name                               Initial  Attn: or c/o, last name                                                                           34
35                                                                                                                                                                            35
36                                                                                                                                                                            36
            XXXXXXXXXXXXXXXX                                       X        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
37          Corporation current address                                                                                                                                       37
38                                                                                                                                                                            38
39                                                                                                                                                                            39
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
40          City                                                                                      State ZIP code                                                          40
41                                                                                                                                                                            41
42          XXXXXXXXXXXXXXXXXXXXXX                                                                    XX    XXXXX-XXXX -                                                      42
43                                                                                                                                                                            43
44          Contact first name                                     Initial  Contact last name                                                                                 44
45                                                                                                                                                                            45
46                                                                                                                                                                            46
            XXXXXXXXXXXXXXXX                                       X        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
47          Contact phone                                                                                                                                                     47
48                                                                                                                                                                            48
49                                                                                                                                                                            49
            999-999-9999
50          Email                                                                                                                                                             50
51                                                                                                                                                                            51
52                                                                                                                                                                            52
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
53                                                                                                                                                                            53
54                                                                                                                                                                            54
55                                                                                                                                                                            55
56                                                                                                                                                                            56
57                                                                                                                         Continued on next page                             57
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                  150-102-025
63                (Rev. 07-18-23, ver. 01)                                                                  02652301010000                                                    63
64                                                                                                                                                                            64
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69                                                                                                                                                                         69
70                                                                                                                                                                         70
                                                                                                                                           Oregon Department of Revenue
71                        2023 Form OR-20-S                                                                                                                                71
72                                                                                                                                                                         72
73                                                                                                                                                                         73
74                        Page 2 of 8      • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     74
75           Only complete questions A through C if this is your first return, or the answer changed during this tax year.                                                 75
76           A. Incorporated in (state)            Incorporated on (date) (MM/DD/YYYY)                                                                                     76
77                                                                                                                                                                         77
78              XX                                 99/99/9999/        /                                                                                                    78
79           B. State of commercial domicile       C. Date business activity began in Oregon (MM/DD/YYYY)         D. NAICS code                                            79
80                                                                                                                                                                         80
81              XX                                 99/99/9999/        /                                                                    999999                          81
82                                                                                                                                                                         82
83                                                                                                                                                                         83
84           E. List the tax years for which federal waivers of the statute of limitations are in effect and dates on which waivers expire                                 84
85                                                                                                                                                                         85
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
86                                                                                                                                                                         86
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
87                                                                                                                                                                         87
88           F. List the tax years for which your federal taxable income was changed by an IRS audit or by an amended federal return filed during this tax year            88
89                                                                                                                                                                         89
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
90                                                                                                                                                                         90
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
91                                                                                                                                                                         91
92                                                                                                                                                                         92
93           G. If first return, indicate: X       New business X     Successor to previous business                                                                       93
94                                                                                                                                                                         94
95              Previous business name                                                                                                                                     95
96                                                                                                                                                                         96
97                                                                                                                                                                         97
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
98              FEIN                                                                                                                                                       98
99                                                                                                                                                                         99
100                                                                                                                                                                        100
                99-9999999
101                                                                                                                                                                        101
102                                                                                                                                                                        102
103          H. If final return, indicate: X       Withdrawn    X     Dissolved        X                          Merged or reorganized                                    103
104                                                                                                                                                                        104
105             Merged or reorganized corporation name                                                                                                                     105
106                                                                                                                                                                        106
107                                                                                                                                                                        107
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
108             FEIN                                                                                                                                                       108
109                                                                                                                                                                        109
110                                                                                                                                                                        110
                99-9999999
111                                                                                                                                                                        111
112                                                                                                                                                                        112
113          I.   X       Utility or telecommunications companies (see instructions).                                                                                      113
114                                                                                                                                                                        114
115          J.   Enter ordinary business income or loss from federal Form 1120-S ..............J.                ,                        , 99,999,999,999.00,        0 0 115
116                                                                                                                                                                        116
117                                                                                                                                                                        117
118          K.   Fill in the amount of your total Oregon sales ...............................................K. ,                        , 99,999,999,999.00,        0 0 118
119                                                                                                                                                                        119
120                                                                                                                                                                        120
121                                                                                                                                                                        121
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123                                                                                                                                               Continued on next page   123
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                          150-102-025
129                       (Rev. 07-18-23, ver. 01)                                                                                         02652301020000                  129
130                                                                                                                                                                        130
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135                                                                                                                                                                      135
136                                                                                                                                                                      136
                                                                                                                                    Oregon Department of Revenue
137                       2023 Form OR-20-S                                                                                                                              137
138                                                                                                                                                                      138
139                                                                                                                                                                      139
140                       Page 3 of 8    • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     140
141                                                                                                                                                                      141
142          S corporations without built-in gains or excess net passive income, fill in your apportionment percentage on                                                142
143          line 6 then enter -0- on lines 7, 8, and 10 and go to line 11.                                                                                              143
144                                                                                                                                                                      144
145            1.  Income taxed on federal Form 1120-S from: (a) Built-in gains (see                                                                                     145
146                 instructions)............................................................................................1a.  , ,      99,999,999,999.00,        0 0 146
147                                                                                                                                                                      147
148                                                                                                                                                                      148
149              (b) Excess net passive income (see instructions) ..................................1b.                           , ,      99,999,999,999.00,        0 0 149
150                                                                                                                                                                      150
151                                                                                                                                                                      151
152                 Total: Line 1a plus line 1b .............................................................Total 1c.            , ,      99,999,999,999.00,        0 0 152
153                                                                                                                                                                      153
154            2.  Total additions from Schedule OR-ASC-CORP, Section A, (only if apply                                                                                  154
155                 to amounts included in line 1, see instructions) .......................................2.                    , ,      99,999,999,999.00,        0 0 155
156                                                                                                                                                                      156
157            3.  Total subtractions from Schedule OR-ASC-CORP, Section B, (only if                                                                                     157
158                 apply to amounts included in line 1, see instructions) .............................3.                        , ,      99,999,999,999.00,        0 0 158
159            4.  S corporation income before net loss deduction (line 1c plus line 2,                                                                                  159
160                 minus line 3) If income is entirely from Oregon sources, continue.                                                                                   160
161                 If from both Oregon and other states, see Schedule OR-AP and                                                                                         161
162                 continue ..................................................................................................4. , ,      99,999,999,999.00,        0 0 162
163                                                                                                                                                                      163
164            5.  Net loss from prior years as C corporation (deductible from built-in                                                                                  164
165                 gain income only) (include schedule, enter as a positive number) ..........5.                                 , ,      99,999,999,999.00,        0 0 165
166                                                                                                                                                                      166
167            6.  Enter the apportionment percentage from Schedule OR-AP, part 1,                                                                                       167
168                 line 23. Enter 100.0000 if you don’t apportion income ............................6.                          999.9999 %                             168
169              You must attach Schedule OR-AP to apportion income.                                                                                                     169
170            7.   Oregon taxable income (line 4 minus line 5, or from Schedule OR-AP,                                                                                  170
171                 part 2, line 12) ..........................................................................................7. , ,      99,999,999,999.00,        0 0 171
172                                                                                                                                                                      172
173                                                                                                                                                                      173
174          Tax                                                                                                                                                         174
175            8.  Calculated tax (see instructions) ..............................................................8.             , ,      99,999,999,999.00,        0 0 175
176                                                                                                                                                                      176
177            9.  Schedule OR-FCG-20 adjustment (see instructions,                                                                                                      177
178                 include schedule) .....................................................................................9.     , ,      99,999,999,999.00,        0 0 178
179                                                                                                                                                                      179
180                                                                                                                                                                      180
181            10.  Total calculated tax (line 8 minus line 9) ................................................10.                , ,      99,999,999,999.00,        0 0 181
182                                                                                                                                                                      182
183                                                                                                                                                                      183
184            11.  Minimum tax (see instructions) ..............................................................11.              , ,      99,999,999,999.00,        0 0 184
185                                                                                                                                                                      185
186                                                                                                                                                                      186
187            12.  Tax (greater of line 10 or line 11) ............................................................12.           , ,      99,999,999,999.00,        0 0 187
188                                                                                                                                                                      188
189                                                                                                                                          Continued on next page      189
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                          150-102-025
195                       (Rev. 07-18-23, ver. 01)                                                                                         02652301030000                195
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201                                                                                                                                                                    201
202                                                                                                                                                                    202
                                                                                                                                 Oregon Department of Revenue
203                       2023 Form OR-20-S                                                                                                                            203
204                                                                                                                                                                    204
205                                                                                                                                                                    205
206                       Page 4 of 8  • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     206
207                                                                                                                                                                    207
208                                                                                                                                                                    208
209            13.  Tax adjustment for installment sales interest (include schedule) ...........13.                            , , 99,999,999,999.00,              0 0 209
210                                                                                                                                                                    210
211                                                                                                                                                                    211
212            14.  Tax before credits (line 12 plus line 13) ..................................................14.            , , 99,999,999,999.00,              0 0 212
213                                                                                                                                                                    213
214                                                                                                                                                                    214
215          Credits                                                                                                                                                   215
216            15.  Total carryforward credits from Schedule OR-ASC-CORP, Section D                                                                                    216
217                 (see instructions) ....................................................................................15. , , 99,999,999,999.00,              0 0 217
218                                                                                                                                                                    218
219                                                                                                                                                                    219
220            16.  Tax after carryforward credits (line 14 minus line 15) .............................16.                    , , 99,999,999,999.00,              0 0 220
221                                                                                                                                                                    221
222                                                                                                                                                                    222
223            17.  LIFO benefit recapture addition (see instructions) .................................17.                    , , 99,999,999,999.00,              0 0 223
224                                                                                                                                                                    224
225                                                                                                                                                                    225
226                                                                                                                                                                    226
227          Net tax                                                                                                                                                   227
228            18.  Net tax (line 16 plus line 17, see instructions) ........................................18.               , , 99,999,999,999.00,              0 0 228
229                                                                                                                                                                    229
230            19.  Estimated tax payments from Schedule ES line 8. Include                                                                                            230
231                 payments made with extension ..............................................................19.             , , 99,999,999,999.00,              0 0 231
232                                                                                                                                                                    232
233            20.  Tax due. Is line 18 more than line 19? If so, line 18 minus                                                                                        233
234                 line 19 .......................................................................................Tax due20.  , , 99,999,999,999.00,              0 0 234
235                                                                                                                                                                    235
236            21.  Overpayment. Is line 18 less than line 19? If so, line 19 minus                                                                                    236
237                 line 18 .............................................................................Overpayment 21.       , , 99,999,999,999.00,              0 0 237
238                                                                                                                                                                    238
239                                                                                                                                                                    239
240            22.  Penalty due with this return (see instructions) .......................................22.                 , , 99,999,999,999.00,              0 0 240
241                                                                                                                                                                    241
242                                                                                                                                                                    242
243            23.  Interest due with this return (see instructions) .......................................23.                , , 99,999,999,999.00,              0 0 243
244                                                                                                                                                                    244
245                                                                                                                                                                    245
246            24.  Interest on underpayment of estimated tax (include Form OR-37) .......24.                                  , , 99,999,999,999.00,              0 0 246
247                                                                                                                                                                    247
248                                                                                                                                                                    248
249            25.  Total penalty and interest (add lines 22 through 24) ..............................25.                     , , 99,999,999,999.00,              0 0 249
250                                                                                                                                                                    250
251                                                                                                                                                                    251
252            26.  Total due (line 20 plus line 25) ...............................................Total due 26.              , , 99,999,999,999.00,              0 0 252
253                                                                                                                                                                    253
254                                                                                                                                                                    254
255                                                                                                                                Continued on next page              255
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260                                                                                                                                                                    260
                          150-102-025
261                       (Rev. 07-18-23, ver. 01)                                                                               02652301040000                        261
262                                                                                                                                                                    262
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267                                                                                                                                                                     267
268                                                                                                                                                                     268
                                                                                                                                   Oregon Department of Revenue
269                       2023 Form OR-20-S                                                                                                                             269
270                                                                                                                                                                     270
271                                                                                                                                                                     271
272                       Page 5 of 8   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     272
273                                                                                                                                                                     273
274                                                                                                                                                                     274
275            27.  Refund available (line 21 minus line 25) ...................................Refund 27.                       , , 99,999,999,999.00,             0 0 275
276                                                                                                                                                                     276
277            28.  Amount of refund to be credited to your open estimated                                                                                              277
278                 tax account ............................................................................................28.  , , 99,999,999,999.00,             0 0 278
279                                                                                                                                                                     279
280                                                                                                                                                                     280
281            29.  Net refund (line 27 minus line 28) .......................................Net refund 29.                     , , 99,999,999,999.00,             0 0 281
282                                                                                                                                                                     282
283                                                                                                                                                                     283
284                                                                                                                                                                     284
             Schedule SM—Oregon modifications passed through to shareholders
285          Federal taxable income passed through to the shareholders is adjusted to the extent that items of income, loss, or deduction of the shareholder are        285
286          required to be adjusted under the provisions of Oregon Revised Statutes, Chapters 314 and 316. Indicate which federal Schedule K-1 line item each          286
287          modification is for. Don’t use Schedule OR-ASC-CORP codes for this section.                                                                                287
288                                                                                                                                                                     288
289          Additions                                                                                                                                                  289
290            1.  Interest on government bonds of other states ........................................1.                       , , 99,999,999,999.00,             0 0 290
291                 K-1 line                                                                                                                                            291
292                                                                                                                                                                     292
293                                                                                                                                                                     293
                        99
294                                                                                                                                                                     294
295            2.  Gain or loss on the sale of depreciable property .....................................2.                      , , 99,999,999,999.00,             0 0 295
296                 K-1 line                                                                                                                                            296
297                                                                                                                                                                     297
298                                                                                                                                                                     298
                        99
299                                                                                                                                                                     299
300            3.  Other addition  (include schedule) ..........................................................3.               , , 99,999,999,999.00,             0 0 300
301                                                                                                                                                                     301
302                                                                                                                                                                     302
303            4.   Total Oregon additions .............................................................................4.       , , 99,999,999,999.00,             0 0 303
304                                                                                                                                                                     304
305                                                                                                                                                                     305
306          Subtractions                                                                                                                                               306
307            5.  Interest from U.S. government, such as Series EE and                                                                                                 307
308                 HH bonds  ................................................................................................5. , , 99,999,999,999.00,             0 0 308
309                 K-1 line                                                                                                                                            309
310                                                                                                                                                                     310
311                                                                                                                                                                     311
                        99
312                                                                                                                                                                     312
313            6.  Gain or loss on the sale of depreciable property .....................................6.                      , , 99,999,999,999.00,             0 0 313
314                 K-1 line                                                                                                                                            314
315                                                                                                                                                                     315
316                                                                                                                                                                     316
                        99
317                                                                                                                                                                     317
318            7.   Work opportunity credit wage reductions ...............................................7.                    , , 99,999,999,999.00,             0 0 318
319                 K-1 line                                                                                                                                            319
320                                                                                                                                                                     320
321                     99                                                                                                           Continued on next page             321
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325                                                                                                                                                                     325
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                          150-102-025
327                       (Rev. 07-18-23, ver. 01)                                                                                 02652301050000                       327
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333                                                                                                                                                                   333
334                                                                                                                                                                   334
                                                                                                                                Oregon Department of Revenue
335                      2023 Form OR-20-S                                                                                                                            335
336                                                                                                                                                                   336
337                                                                                                                                                                   337
338                      Page 6 of 8  • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     338
339                                                                                                                                                                   339
340                                                                                                                                                                   340
341            8.  Other subtraction  (include schedule) .....................................................8.              , , 99,999,999,999.00,              0 0 341
342                                                                                                                                                                   342
343                                                                                                                                                                   343
344            9.  Total Oregon subtractions ........................................................................9.       , , 99,999,999,999.00,              0 0 344
345                                                                                                                                                                   345
346                                                                                                                                                                   346
347          Schedule ES—Estimated tax payments, other prepayments, and refundable credits                                                                            347
348          1. Quarter 1                                                                                                                                             348
349          Payer name                                                                                                                                               349
350                                                                                                                                                                   350
351                                                                                                                                                                   351
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
352          Payer FEIN                                 Date paid                                                                                                     352
353                                                                                                                                                                   353
354          99-9999999                                 99/99/9999/ /                                                                                                 354
355                                                                                                                                                                   355
356                                                                                                                                                                   356
357            1.  Amount paid.............................................................................................1. , , 99,999,999,999.00,              0 0 357
358                                                                                                                                                                   358
359                                                                                                                                                                   359
360          2. Quarter 2                                                                                                                                             360
361          Payer name                                                                                                                                               361
362                                                                                                                                                                   362
363                                                                                                                                                                   363
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
364          Payer FEIN                                 Date paid                                                                                                     364
365                                                                                                                                                                   365
366          99-9999999                                 99/99/9999/ /                                                                                                 366
367                                                                                                                                                                   367
368                                                                                                                                                                   368
369            2.  Amount paid.............................................................................................2. , , 99,999,999,999.00,              0 0 369
370                                                                                                                                                                   370
371                                                                                                                                                                   371
372          3. Quarter 3                                                                                                                                             372
373          Payer name                                                                                                                                               373
374                                                                                                                                                                   374
375                                                                                                                                                                   375
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
376          Payer FEIN                                 Date paid                                                                                                     376
377                                                                                                                                                                   377
378          99-9999999                                 99/99/9999/ /                                                                                                 378
379                                                                                                                                                                   379
380                                                                                                                                                                   380
381            3.  Amount paid.............................................................................................3. , , 99,999,999,999.00,              0 0 381
382                                                                                                                                                                   382
383                                                                                                                                                                   383
384                                                                                                                                                                   384
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387                                                                                                                               Continued on next page              387
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                         150-102-025
393                      (Rev. 07-18-23, ver. 01)                                                                               02652301060000                        393
394                                                                                                                                                                   394
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399                                                                                                                                                                  399
400                                                                                                                                                                  400
                                                                                                                                     Oregon Department of Revenue
401                      2023 Form OR-20-S                                                                                                                           401
402                                                                                                                                                                  402
403                                                                                                                                                                  403
404                      Page 7 of 8 • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     404
405                                                                                                                                                                  405
406          4. Quarter 4                                                                                                                                            406
407          Payer name                                                                                                                                              407
408                                                                                                                                                                  408
409                                                                                                                                                                  409
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
410          Payer FEIN                                  Date paid                                                                                                   410
411                                                                                                                                                                  411
412          99-9999999                                  99/99/9999/          /                                                                                      412
413                                                                                                                                                                  413
414                                                                                                                                                                  414
415            4.  Amount paid.............................................................................................4.      , , 99,999,999,999.00,        0 0 415
416                                                                                                                                                                  416
417                                                                                                                                                                  417
418            5.  Overpayment of another year’s tax applied as a credit against this                                                                                418
419                year’s tax ..................................................................................................5. , , 99,999,999,999.00,        0 0 419
420                                                                                                                                                                  420
421                                                                                                                                                                  421
422            6.  Payments made with extension or other prepayments for this tax year ...6.                                       , , 99,999,999,999.00,        0 0 422
423                Date paid (MM/DD/YYYY)                                                                                                                            423
424                                                                                                                                                                  424
425                99/99/9999/       /                                                                                                                               425
426                                                                                                                                                                  426
427            7.  Reserved ..................................................................................................7.                                     427
428                                                                                                                                                                  428
429                                                                                                                                                                  429
430            8.  Total prepayments (carry to line 19 above) ..............................................8.                     , , 99,999,999,999.00,        0 0 430
431                                                                                                                                                                  431
432                                                                                                                                                                  432
433                                                                                                                                                                  433
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458                                                                                                                                                                  458
                         150-102-025
459                      (Rev. 07-18-23, ver. 01)                                                                                    02652301070000                  459
460                                                                                                                                                                  460
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465                                                                                                                                                                465
466                                                                                                                                                                466
                                                                                                     Oregon Department of Revenue
467                        2023 Form OR-20-S                                                                                                                       467
468                                                                                                                                                                468
469                                                                                                                                                                469
470                        Page 8 of 8 • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples. 470
471                                                                                                                                                                471
472          Under penalty of false swearing, I declare that the information in this return and any enclosures are true, correct, and complete.                    472
473          Officer signature                                                                                                                                     473
474                                                                                                                                                                474
475          X                                                                                                                                                     475
476          Date (MM/DD/YYYY)                                                                                                                                     476
477                                                                                                                                                                477
478          99/99/9999/         /                                                                                                                                 478
479          Officer first name                             Initial Officer last name                                                                              479
480                                                                                                                                                                480
481                                                                                                                                                                481
             XXXXXXXXXXXXXXXX                               X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
482          Officer title                                                                                                                                         482
483                                                                                                                                                                483
484                                                                                                                                                                484
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
485                                                                                                                                                                485
486          X    Check the box to authorize the following individual(s) to receive and provide confidential tax information relating to this return.              486
487                                                                                                                                                                487
488          Preparer signature other than taxpayer                                                                                                                488
489                                                                                                                                                                489
490          X                                                                                                                                                     490
491          Date (MM/DD/YYYY)                       Phone                                   Preparer license number                                               491
492                                                                                                                                                                492
493          99/99/9999/         /                   999-999-9999                            XXXXXXXXXX                                                            493
494          Preparer first name                            Initial Preparer last name                                                                             494
495                                                                                                                                                                495
496                                                                                                                                                                496
             XXXXXXXXXXXXXXXX                               X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
497          Preparer address                                                                                                                                      497
498                                                                                                                                                                498
499                                                                                                                                                                499
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
500          City                                                                      State         ZIP code                                                      500
501                                                                                                                                                                501
502          XXXXXXXXXXXXXXXXXXXXXX                                                    XX            XXXXX-XXXX -                                                  502
503                                                                                                                                                                503
504          Mail refund returns and no tax due returns to: Mail tax-to-pay returns with payment to:                                                               504
505          Refund, PO Box 14777, Salem OR 97309-0960      Oregon Department of Revenue, PO Box 14790, Salem OR 97309-0470                                        505
506          Do not include a payment voucher with your return. Include a complete copy of your federal Form 1120-S and schedules, including all federal           506
507          K-1s or K-1 summary (see instructions).                                                                                                               507
508                                                                                                                                                                508
509                                                                                                                                                                509
510                                                                                                                                                                510
511                                                                                                                                                                511
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                           150-102-025
525                        (Rev. 07-18-23, ver. 01)                                                  02652301080000                                                525
526                                                                                                                                                                526
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