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                                                                                                          Oregon Department of Revenue
5                       Form OR-OC-V                                                                                                                                      5
6                       Oregon Composite Return 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 end date for majority of owners on composite return (MM/DD/YYYY)                                                                                     9
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11          99/99/9999/        /                                                                                                                                          11
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13          Pass-through entity (PTE) name                                                                                                                                13
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16          Federal employer identification number (FEIN)                                                                                                                 16
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            99-9999999
19          PTE address                                                                                                                                                   19
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22          City                                                                              State       ZIP code                                                        22
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            XXXXXXXXXXXXXXXXXXXXXX                                                            XX          XXXXX-XXXX
25          Contact first name                                                        Initial                                                                             25
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            XXXXXXXXXXXXXXXX                                                          X
28          Contact last name                                                                                                                                             28
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
31          Contact phone                                                                                                                                                 31
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            999-999-9999
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46                                                                                            Payment type (check one)                                                    46
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48          Want to make your payment online? Find options at www.oregon.gov/dor.             X Original return or extension                                              48
49          Use this voucher only if you are sending a payment separate from a return. For                                                                                49
50          more information, see Form OR-OC-V Instructions. Make your check, money order,      Estimated payment                                                         50
51          or cashier’s check payable to the Oregon Department of Revenue. Write “Form       X                                                                           51
            OR-OC-V,” your daytime phone, the entity’s FEIN, and the tax year on the payment. 
52          Don’t mail cash. Mail the payment and voucher 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                                         150-101-150                                                                                                                    59
                                           (Rev. 04-27-23, ver. 05)
60                                                                                    9999 99 $           ,            99,999,999.00,                           0 0       60
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63                                                        XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                              63
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