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                                                                                                        Oregon Department of Revenue
5                Form OR-20-V                                                                                                                                                 5
6                Oregon Corporation Tax Payment Voucher                                                                                                                       6
7                                                                                                                                                                             7
8                Page 1 of 1            • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           8
9           Tax year beginning (MM/DD/YYYY)               Tax year ending (MM/DD/YYYY)                                                                                        9
10                                                                                                                                                                            10
11          99/99/9999/        /                          99/99/9999/ /                                                                                                       11
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13          Contact first name                                          Initial                                                                                               13
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            XXXXXXXXXXXXXXXX                                            X
16          Contact last name                                                                                                                                                 16
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19          Corporation legal name of filer on tax return                                                                                                                     19
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22          Federal employer identification number (FEIN)                                                                                                                     22
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            99-9999999
25          Corporation current address                                                                                                                                       25
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
28          City                                                                             State      ZIP code                                                              28
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            XXXXXXXXXXXXXXXXXXXXXX                                                           XX         XXXXX-XXXX
31          Contact phone                                                                                                                                                     31
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            999-999-9999
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46                                                                                          Payment type (check one)                                                          46
47                                                                                                                                                                            47
48          Want to make your payment online? Find options at www.oregon.gov/dor.             Original return or extension                                                    48
                                                                                            X
49          Use this voucher only if you’re sending a payment separate from a return. Make                                                                                    49
50          your check, money order, or cashier’s check payable to the Oregon Department of   Estimated payment                                                               50
51          Revenue. Write “Form OR-20-V,” the filer name, FEIN, the tax year beginning and X                                                                                 51
            ending dates, and a daytime phone on your payment. Don’t mail cash. Mail the 
52          voucher and payment to:                                                         X Amended return                                                                  52
53                                                                                                                                                                            53
54          Oregon Department of Revenue                                                                                                                                      54
            PO Box 14950
55          Salem OR 97309-0950                                                                                                                                               55
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57                                                                                          Enter payment amount                                                              57
58                                                                                                                                                                            58
59                                          150-102-172                                                                                                                       59
                                            (Rev. 05-10-23, ver. 05)
60                                                                    9999 99               $           ,            99,999,999.00,                                 0 0       60
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63                                                        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                  63
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