Enlarge image | 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 With grid With grid & data2 84 85 3 4 82 83 3 3 4 4 5 Office use only 5 2023 Form OR-STI 6 Page 1 of 1, 150-101-071 Oregon Department of Revenue 19342301010000 6 7 (Rev. 06-30-23, ver. 01) 7 8 Oregon Statewide Transit Individual Tax Return 8 9 9 10 10 11 Submit original form—do not submit photocopy. 11 12 12 13 X Amended return X Extension filed 13 14 14 15 First name Initial Last name Social Security number (SSN) 15 16 16 17 XXXXXXXXXXXXCurrent mailing address X XXXXXXXXXXXXXXXXXXXX 999-99-9999Date of-birth- 17 18 18 19 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCity State ZIP code Country 99/99/9999Phone/ / 19 20 20 XXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX XXXXXXXXXXXXXXXXXXXXX ((999)) 999-9999- 21 21 22 Caution: This form applies to a limited number of employees. See the instructions before filing this form. 22 23 23 24 1. Taxable wages (see instructions) ..........................................................................................................1. 99,999,999,999.00.00 24 25 2. Tax. Line 1 multiplied by 0.001. Round to the nearest dollar ...............................................................2. 99,999,999,999.00.00 25 26 3. Tax withheld from Form(s) W-2 box 14 (see instructions). Include a copy of your Form(s) W-2. .........3. 99,999,999,999.00.00 26 27 4. Enter payments you made prior to the filing of this return (see instructions) .......................................4. 99,999,999,999.0099,999,999,999.00.00.00 27 28 5. Total payments and tax withheld. Add lines 3 and 4 ........................................................................5. 99,999,999,999.0099,999,999,999.00.00.00 28 29 6. Penalty and interest for filing or paying late (see instructions) .............................................................6. 99,999,999,999.00.00 29 30 7. Tax plus penalty and interest. Add lines 2 and 6 ..................................................................................7. 99,999,999,999.00.00 30 31 8. Tax to pay. If line 5 is less than line 7, you have tax to pay. Line 7 minus line 5 .................................8. 99,999,999,999.00.00 31 32 9. Refund. If line 5 is more than line 7, you overpaid. Line 5 minus line 7 ..............................................9. 99,999,999,999.00.00 32 33 33 34 34 35 Direct deposit 35 36 10. For direct deposit of your refund, see instructions. Check the box if this refund will go to an account outside the United States: 36 X 37 37 38 Type of account: Checking or Savings 38 X X 39 39 40 Routing number: 40 999999999 41 41 42 Account number: 42 XXXXXXXXXXXXXXXXX 43 43 44 44 45 45 46 Sign here. Under penalty of false swearing, I declare the information in this return and any attachments is true, correct, and complete. 46 47 Your signature Date 47 48 X 99/99/9999/ / 48 49 Signature of preparer other than taxpayer Preparer phone Preparer license number, if professionally prepared 49 50 X ((999))999-9999– XXXXXXXXXX 50 51 Preparer mailing address City State ZIP code 51 52 52 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX 53 53 Important: Include a copy of your Form(s) W-2. We may adjust your return without it. 54 54 55 File and pay online: 55 56 You may file and pay electronically at www.oregon.gov/dor by using Revenue Online. 56 57 57 Mail your return and payment: 58 58 For payments make your check or money order payable to “Oregon Department of Revenue.” 59 59 Write “2023 Oregon Form OR-STI” and the last four digits of your social security number on the memo line. Don’t mail cash. 60 60 61 Mail to: Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940. 61 62 62 63 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 |