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                                                                                                       Oregon Department of Revenue
5                     Form OR-65-V                                                                                                                                            5
6                     Oregon Partnership Income 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 begins (MM/DD/YYYY)                  Tax year ends (MM/DD/YYYY)                                                                                          9
10                                                                                                                                                                            10
11          99/99/9999/           /                       99/99/9999/ /                                                                                                       11
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13          Partnership name                                                                                                                                                  13
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16          Federal employer identification number (FEIN)                                                                                                                     16
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            99-9999999
19          Partnership mailing address                                                                                                                                       19
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22          City                                                                           State       ZIP code                                                               22
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            XXXXXXXXXXXXXXXXXXXXXX                                                         XX          XXXXX-XXXX
25          First name of partner who has the partnership books         Initial                                                                                               25
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            XXXXXXXXXXXXXXXX                                            X
28          Last name                                                                                                                                                         28
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
31          Partner 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.          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-65-V Instructions. Make your check, money order,   Amended return                                                                   50
51          or cashier’s check payable to the Oregon Department of Revenue. Write “Form    X                                                                                  51
52          OR-65-V,” your daytime phone, the partnership’s FEIN, and the tax year on the                                                                                     52
            payment. Don’t mail cash. Mail the payment and voucher to:
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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                                       150-101-066                                                                                                                          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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