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5                                                                                                                                            Oregon Department of Revenue     5
                        2022 Schedule OR-AF-CAT
6                       Schedule of Affiliates for Form OR-CAT                                                                                                                6
7                                                                                                                                                                             7
8                       Page 1 of 2    • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.            8
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10          Legal name of designated Corporate Activity Tax (CAT) entity (sole proprietor—complete the next line)                                                             10
11                                                                                                                                                                            11
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13          First name (if sole proprietorship)                          Initial Last name                                                                                    13
14                                                                                                                                                                            14
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            XXXXXXXXXXXXXXXX                                             X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16          Federal employer identification number (FEIN) Social Security number (SSN)                                                                                        16
17                                                                                                                                                                            17
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            99-9999999                                    999-99-9999
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20          A Schedule of Affiliates must be filed every year with each combined return. List all affiliates with commercial activity in Oregon that                          20
21          are part of the unitary group included in this return.                                                                                                            21
22                                                                                                                                                                            22
23          Don’t include the designated CAT entity filing this tax return on this schedule. Make a copy of this form if you have more than two affiliates.                   23
24          1a. FEIN                                      1b. Social Security number (SSN)                                                                                    24
25                                                                                                                                                                            25
26                                                                                                                                                                            26
            99-9999999                                    999-99-9999
27          1c. Business name                                                                                                                                                 27
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
30          1d. Address                                                                                                                                                       30
31                                                                                                                                                                            31
32                                                                                                                                                                            32
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
33          1e. City                                                                                              1f. State                  1g. ZIP code                     33
34                                                                                                                                                                            34
35          XXXXXXXXXXXXXXXXXXXXXX                                                                                XX                         XXXXX-XXXX -                     35
36          1h. If new affiliate during this year, enter date affiliate  1i. If affiliate ceased to be part of the unitary group during this                                  36
37          became part of the unitary group. Date (MM/DD/YYYY)          year, indicate date affiliate left group. Date (MM/DD/YYYY)                                          37
38                                                                                                                                                                            38
39          99/99/9999/           /                                      99/99/9999/   /                                                                                      39
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41                                                                                                                                                                            41
42            1j.  Amount of Oregon commercial activity ................................................. 1j.     ,                          , 99,999,999,999.00,         0 0 42
43                                                                                                                                                                            43
44          1k. Business activity code                                                                                                                                        44
45                                                                                                                                                                            45
46                                                                                                                                                                            46
                        999999
47          1l. Tax entity type                                                                                                                                               47
48                                                                                                                                                                            48
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            XX
50          1m. Legal entity type                                                                                                                                             50
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            XX
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55                                                                       Include additional schedules if needed.                                                              55
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                        150-106-005
63                      (Rev. 06-10-22, ver. 01)                                                                                             20552201010000                   63
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70                                                                                                                                                                             70
71                       2022 Schedule OR-AF-CAT                                                                                              Oregon Department of Revenue     71
72                                                                                                                                                                             72
73                                                                                                                                                                             73
74                       Page 2 of 2    • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.            74
75                                                                                                                                                                             75
76           2a. FEIN                                    2b. Social Security number (SSN)                                                                                      76
77                                                                                                                                                                             77
78                                                                                                                                                                             78
             99-9999999                                  999-99-9999
79           2c. Business name                                                                                                                                                 79
80                                                                                                                                                                             80
81                                                                                                                                                                             81
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
82           2d. Address                                                                                                                                                       82
83                                                                                                                                                                             83
84                                                                                                                                                                             84
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
85           2e. City                                                                                          2f. State                      2g. ZIP code                     85
86                                                                                                                                                                             86
87           XXXXXXXXXXXXXXXXXXXXXX                                                                            XX                             XXXXX-XXXX -                     87
88           2h. If new affiliate during this year, enter date affiliate  2i. If affiliate ceased to be part of the unitary group during this                                  88
89           became part of the unitary group. Date (MM/DD/YYYY)          year, indicate date affiliate left group. Date (MM/DD/YYYY)                                          89
90                                                                                                                                                                             90
91           99/99/9999/           /                                      99/99/9999/ /                                                                                        91
92                                                                                                                                                                             92
93                                                                                                                                                                             93
94             2j.  Amount of Oregon commercial activity ................................................. 2j. ,                              , 99,999,999,999.00,         0 0 94
95                                                                                                                                                                             95
96           2k. Business activity code                                                                                                                                        96
97                                                                                                                                                                             97
98                                                                                                                                                                             98
                         999999
99           2l. Tax entity type                                                                                                                                               99
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             XX
102          2m. Legal entity type                                                                                                                                             102
103                                                                                                                                                                            103
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             XX
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                         150-106-005
129                      (Rev. 06-10-22, ver. 01)                                                                                             20552201020000                   129
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