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5                                                                                                                   Oregon Department of Revenue                    5
                  2024 Schedule OR-EXC-CAT
6                 Exclusions From Commercial Activity                                                                                                               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                                                                                                                                                                   9
10          Legal name of designated Corporate Activity Tax (CAT) entity (sole proprietor—complete the next line)                                                   10
11                                                                                                                                                                  11
12                                                                                                                                                                  12
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13          First name (if sole proprietorship)           Initial Last name                                                                                         13
14                                                                                                                                                                  14
15                                                                                                                                                                  15
            XXXXXXXXXXXXXXXX                              X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16          Federal employer identification number (FEIN) Social Security number (SSN)                                                                              16
17                                                                                                                                                                  17
18                                                                                                                                                                  18
            99-9999999                                    999-99-9999
19                                                                                                                                                                  19
20          Use this form to report exclusions from commercial activity on your Oregon Corporate Activity Tax Return. Use codes from Appendix                       20
21          A from the 2024 Form OR-CAT instructions. If you have more items than will fit on a single schedule, provide the codes and amounts                      21
22          on additional schedules and add the total to your tax return. Include all the schedules with your return.                                               22
23          You must include this schedule with your Oregon Corporate Activity Tax Return if you are claiming any exclusions from commercial activity.              23
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25                                                                                                                                                                  25
26          Exclusions from commercial activity                                                                                                                     26
27                Code                                                                  Amount                                                                      27
28                                                                                                                                                                  28
29          1.    999                                                                     2.                      , , 99,999,999,999.00,                  0 0       29
30                                                                                                                                                                  30
31                                                                                                                                                                  31
32          3.    999                                                                     4.                      , , 99,999,999,999.00,                  0 0       32
33                                                                                                                                                                  33
34                                                                                                                                                                  34
35          5.    999                                                                     6.                      , , 99,999,999,999.00,                  0 0       35
36                                                                                                                                                                  36
37                                                                                                                                                                  37
38          7.    999                                                                     8.                      , , 99,999,999,999.00,                  0 0       38
39                                                                                                                                                                  39
40                                                                                                                                                                  40
41          9.    999                                                                    10.                      , , 99,999,999,999.00,                  0 0       41
42                                                                                                                                                                  42
43                                                                                                                                                                  43
44          11.   999                                                                    12.                      , , 99,999,999,999.00,                  0 0       44
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46                                                                                                                                                                  46
47          13.   999                                                                    14.                      , , 99,999,999,999.00,                  0 0       47
48                                                                                                                                                                  48
49                                                                                                                                                                  49
50          15.   999                                                                    16.                      , , 99,999,999,999.00,                  0 0       50
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52                                                                                                                                                                  52
53          17.   999                                                                    18.                      , , 99,999,999,999.00,                  0 0       53
54                                                                                                                                                                  54
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56                                                                                      Total                     , , 99,999,999,999.00,                  0 0       56
57                                                                                                                                                                  57
58                                                                                             Enter total on Form OR-CAT, line 2                                   58
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                  150-106-004
63                (Rev. 05-03-24, ver. 01)                                                                          20542401010000                                  63
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