1 1
1 2 2 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 Form All layers With grid &2 data 84 85
3 4 82 83
3 3
4 4
Oregon Department of Revenue
5 Form OR-41-V 5
6 Oregon Fiduciary Income 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
12 12
13 Trust or estate name on tax return 13
14 14
15 15
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16 Trust or estate federal employer identification number (FEIN) 16
17 17
18 18
99-9999999
19 Executor or trustee name 19
20 20
21 21
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22 Street address or PO Box 22
23 23
24 24
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
25 City State ZIP code 25
26 26
27 27
XXXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX
28 Phone 28
29 29
30 30
999-999-9999
31 31
32 32
33 33
34 34
35 35
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
46 Payment type (check one) 46
47 Want to make your payment online? Find options at www.oregon.gov/dor. 47
48 Use this voucher only if you’re sending a payment separate from a return. Make X Original return or extension 48
49 your check, money order, or cashier’s check payable to the Oregon Department 49
of Revenue. Write “Form OR-41-V,” the trust or estate name, FEIN, the tax year
50 beginning and ending dates, and a daytime phone on your payment. Don’t mail X Prepayment 50
51 cash. 51
Mail the voucher and payment to:
52 X Amended return 52
53 53
54 Oregon Department of Revenue 54
PO Box 14950
55 Salem OR 97309-0950 55
56 56
57 Enter payment amount 57
58 58
59 150-101-173 59
(Rev. 05-10-23, ver. 05)
60 9999 99 $ , 99,999,999.00, 0 0 60
61 61
62 62
63 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 63
64 64
1 2 65 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 65 84 85
3 4 82 83
66 66