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5           2024 Form OR-19                                                                                                                                         Office use only      5
6           Page 1 of 2, 150-101-182               Oregon Department of Revenue                                      15772401010000                                                      6
7           (Rev. 07-05-24, ver. 01)                                                                                                                                                     7
8           Annual Report of Pass-through Entity Owner Tax Payments                                                                                                                      8
9                                                                                                                                                                                        9
10                                                                                                                                                                                       10
11                                                               Submit original form—do not submit photocopy.                                                                           11
12          Pass-through entity (PTE) name                                                                          Federal employer identification number (FEIN)                        12
13          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                     99-9999999–                                                          13
14          PTE address                                                                                        City                                 State         ZIP code               14
15                                                                                                                                                                                       15
16          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXContact first name (see instructions) Initial Contact last name XXXXXXXXXXXXXXXXXXXXXContact phone   XX            XXXXX-XXXX             16

17          XXXXXXXXXXXX                   X                   XXXXXXXXXXXXXXXXXXXX                                             999-999-9999– –                                          17
18          Section 1                                                                                                                                                                    18
19                                                                                                                                                                                       19
20          Type of entity: X        Partnership               X S corporation   X                             LLC   X          LLP    X LP         X             Trust                  20
21                                                                                                                                                                                       21
22                                                                                                                                                                                       22
23                                                                                                                                                                                       23
24                                         Estimated payments                    Payment amount                                        Payment date                                      24
25                                                                                                                                     (MM/DD/YYYY)                                      25
26                                                                                                                                                                                       26
27                                                             Payment 1    99,999,999,999.00.00                                99/99/9999/ /                                            27
28                                                                                                                                                                                       28
29                                                                                                                                                                                       29
30                                                             Payment 2    99,999,999,999.00.00                                99/99/9999/ /                                            30
31                                                                                                                                                                                       31
32                                                                                                                                                                                       32
33                                                             Payment 3    99,999,999,999.00.00                                99/99/9999/ /                                            33
34                                                                                                                                                                                       34
35                                                                                                                                                                                       35
36                                                             Payment 4    99,999,999,999.00.00                                99/99/9999/ /                                            36
37                                                                                                                                                                                       37
38                                         Important—Complete page 2 before signing and mailing form.                                                                                    38
39                                                                                                                                                                                       39
40                                                                                                                                                                                       40
41                                                                                                                                                                                       41
42          Sign below and keep a copy of this return for your tax records.                                                                                                              42
43          Under penalties for false swearing, I certify that I am authorized to request transfer of estimated tax payments from the above-                                             43
44          named pass-through entity’s tax account to the tax accounts listed on this form.                                                                                             44
45                                                                                                                                                                                       45
46          General partner, LLC member, or officer signature                                                  Title                                                                     46

47          X                                                                                                  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                       47
48          General partner, LLC member, or officer first name         Initial   Last name                                                  Date                                         48
49          XXXXXXXXXXXX                                               X         XXXXXXXXXXXXXXXXXXXX                                       99/99/9999/           /                      49
50          Paid preparer first name                                   Initial   Last name                                                  Date                                         50
51          XXXXXXXXXXXX                                               X         XXXXXXXXXXXXXXXXXXXX                                       99/99/9999/           /                      51
52          Paid preparer signature                                                                            Preparer address                                                          52

53          X                                                                                                  XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                       53
54                                                                                                             City                                 State           ZIP code             54
55          You can mail Form OR-19 to:                                                                        XXXXXXXXXXXXXXXXXXXXX XX                             XXXXX-XXXX           55
56          Oregon Department of Revenue                                                                       Preparer license number              Phone                                56
57          PO Box 14950                                                                                                                            999-999-9999–       –                57
                                                                                                               XXXXXXXXXX
58          Salem OR 97309-0950                                                                                                                                                          58
59                                                                                                                                                                                       59
60                                   This form is due on the last day of the second month after the end of the entity’s tax year.                                                        60
61                                         The due date for entities using a calendar 2024 tax year is February 28, 2025.                                                                61
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5           2024 Form OR-19                                                                                                                                 5
6           Page 2 of 2, 150-101-182          Oregon Department of Revenue     15772401020000                                                               6
7           (Rev. 07-05-24, ver. 01)                                                                                                                        7
8           Section 2 —Submit additional copies of this page when reporting for more than four owners                                                       8
9           (1) Owner first name      Initial Last name                    Social Security number (SSN) Owner type (see instructions)                       9
10                                    X                                    999-99-9999–   –             XXXXXXXXXXXXX                                       10
11          XXXXXXXXXXXXEntity name           XXXXXXXXXXXXXXXXXXXX                        FEIN                                                              11

12          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                           99-9999999–                                                       12
13          Address                                                  City                               State   ZIP code                                    13
14                                                                                                                                                          14
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                      XXXXXXXXXXXXXXXXXXXXX              XX      XXXXX-XXXX
15                  (a) Payment 1                 (b) Payment 2                (c) Payment 3                (d) Payment 4                                   15
16                                                                                                                                                          16
            99,999,999,999.00.00              99,999,999,999.00.00         99,999,999,999.00.00         99,999,999,999.00.00
17                                                                                                                                                          17
18                                                                                                          Total for owner                                 18
19                                                                                                                                                          19
                                                                                                        99,999,999,999.00.00
20                                                                                                                                                          20
21          (2) Owner first name      Initial Last name                    SSN                          Owner type (see instructions)                       21
22                                    X                                    999-99-9999–   –             XXXXXXXXXXXXX                                       22
23          XXXXXXXXXXXXEntity name           XXXXXXXXXXXXXXXXXXXX                        FEIN                                                              23

24          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                           99-9999999–                                                       24
25          Address                                                  City                               State   ZIP code                                    25
26                                                                                                                                                          26
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                      XXXXXXXXXXXXXXXXXXXXX              XX      XXXXX-XXXX
27                  (a) Payment 1                 (b) Payment 2                (c) Payment 3                (d) Payment 4                                   27
28                                                                                                                                                          28
            99,999,999,999.00.00              99,999,999,999.00.00         99,999,999,999.00.00         99,999,999,999.00.00
29                                                                                                                                                          29
30                                                                                                          Total for owner                                 30
31                                                                                                                                                          31
                                                                                                        99,999,999,999.00.00
32                                                                                                                                                          32
33          (3) Owner first name      Initial Last name                    SSN                          Owner type (see instructions)                       33
34                                    X                                    999-99-9999–   –             XXXXXXXXXXXXX                                       34
35          XXXXXXXXXXXXEntity name           XXXXXXXXXXXXXXXXXXXX                        FEIN                                                              35

36          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                           99-9999999–                                                       36
37          Address                                                  City                               State   ZIP code                                    37
38                                                                                                                                                          38
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                      XXXXXXXXXXXXXXXXXXXXX              XX      XXXXX-XXXX
39                  (a) Payment 1                 (b) Payment 2                (c) Payment 3                (d) Payment 4                                   39
40                                                                                                                                                          40
            99,999,999,999.00.00              99,999,999,999.00.00         99,999,999,999.00.00         99,999,999,999.00.00
41                                                                                                                                                          41
42                                                                                                          Total for owner                                 42
43                                                                                                                                                          43
                                                                                                        99,999,999,999.00.00
44                                                                                                                                                          44
45          (4) Owner first name      Initial Last name                    SSN                          Owner type (see instructions)                       45
46                                    X                                    999-99-9999–   –             XXXXXXXXXXXXX                                       46
47          XXXXXXXXXXXXEntity name           XXXXXXXXXXXXXXXXXXXX                        FEIN                                                              47

48          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                           99-9999999–                                                       48
49          Address                                                  City                               State   ZIP code                                    49
50                                                                                                                                                          50
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                      XXXXXXXXXXXXXXXXXXXXX              XX      XXXXX-XXXX
51                  (a) Payment 1                 (b) Payment 2                (c) Payment 3                (d) Payment 4                                   51
52                                                                                                                                                          52
            99,999,999,999.00.00              99,999,999,999.00.00         99,999,999,999.00.00         99,999,999,999.00.00
53                                                                                                                                                          53
54                                                                                                          Total for owner                                 54
55                                                                                                                                                          55
                                                                                                        99,999,999,999.00.00
56                                                                                                                                                          56
57          Total payments to transfer to owners. Use additional copies of this page for additional owners. If using more than one page, total all payments 57
58          on last page only. These amounts must match estimated payments 1–4 on page 1.                                                                   58
59             (a) Total of payment 1         (b) Total of payment 2       (c) Total of payment 3       (d) Total of payment 4                              59
60                                                                                                                                                          60
            99,999,999,999.00.00              99,999,999,999.00.00         99,999,999,999.00.00         99,999,999,999.00.00
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