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5 2022 Schedule OR-K-1 Office use only 5
6 Page 1 of 1, 150-101-002 Oregon Department of Revenue 17612201010000 6
7 (Rev. 08-12-22, ver. 01) 7
8 Distributive Share of Income, Deductions, Credits, etc. 8
9 For individual owners of pass-through entities 9
10 10
11 11
12 Beginning Ending 12
13 X Final OR-K-1 X Amended OR-K-1 For calendar year 2022 13
14 or fiscal year 99/99/9999/ / 99/99/9999/ / 14
15 Part I—Pass-through entity (PTE) information 15
16 Federal employer identification number PTE name Business code number 16
17 17
18 99-9999999Address- XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXCity State 9999999999ZIP code 18
19 19
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX
20 20
21 Part II—Owner information 21
22 Social Security number Owner’s first name Initial Last name 22
23 23
24 999-99-9999- - XXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXAddress 24
25 X General partner or LLC member manager X Shareholder XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 25
26 City State ZIP code 26
27 X Limited partner or other LLC member X Beneficiary XXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX 27
28 28
29 Oregon resident? If no, state of legal residence Check the appropriate box Owner’s share of profit & loss/stock ownership 29
30 Beginning End 30
31 Yes No Form Form Form Not % % 31
X X XX X X X X 999.9999. 999.9999.
32 OR-OC OR-19 OR-19-AF required 32
33 Part III—Distributive share items 33
34 (a) (b) 34
35 Apportionment percentage 999.9999. % Federal column Oregon column 35
36 Income (losses) 36
37 1. Ordinary business income (loss) ..................................................1. 99,999,999,999.00.00 99,999,999,999.00.00 37
38 2. Net rental real estate income (loss) ..............................................2. 99,999,999,999.00.00 99,999,999,999.00.00 38
39 3. Other net rental income (loss) ......................................................3. 99,999,999,999.00.00 99,999,999,999.00.00 39
40 4. Guaranteed payments to partners ...............................................4. 99,999,999,999.00.00 99,999,999,999.00.00 40
41 5. Interest income .............................................................................5. 99,999,999,999.00.00 99,999,999,999.00.00 41
42 6. Ordinary/qualified dividends ........................................................6. 99,999,999,999.00.00 99,999,999,999.00.00 42
43 7. Royalties .......................................................................................7. 99,999,999,999.00.00 99,999,999,999.00.00 43
44 8. Net short-term capital gain (loss) .................................................8. 99,999,999,999.00.00 99,999,999,999.00.00 44
45 9. Net long-term capital gain (loss) ..................................................9. 99,999,999,999.00.00 99,999,999,999.00.00 45
46 10. Net section 1231 gain (loss) .......................................................10. 99,999,999,999.00.00 99,999,999,999.00.00 46
47 11. Other income (loss) (include schedule) ......................................11. 99,999,999,999.00.00 99,999,999,999.00.00 47
48 Adjustments 48
49 12. IRC section 179 expense ...........................................................12. 99,999,999,999.00.00 99,999,999,999.00.00 49
50 13. Other adjustments (include schedule) ........................................13. 99,999,999,999.00.00 99,999,999,999.00.00 50
51 Oregon additions 51
52 14. Interest on state and local government bonds .............................14. 99,999,999,999.00.00 99,999,999,999.00.00 52
53 15. Other additions (include schedule) .............................................15. 99,999,999,999.00.00 99,999,999,999.00.00 53
54 Oregon subtractions 54
55 16. U.S. government interest ...........................................................16. 99,999,999,999.00.00 99,999,999,999.00.00 55
56 17. Depreciation ...............................................................................17. 99,999,999,999.00.00 99,999,999,999.00.00 56
57 18. Other subtractions (include schedule) .......................................18. 99,999,999,999.00.00 99,999,999,999.00.00 57
58 Oregon credits 58
59 19. Credits (include schedule) ..............................................................................................................19. 99,999,999,999.00.00 59
60 Payments 60
61 20. PTE owner payment from Form OR-19..........................................................................................20. 99,999,999,999.00.00 61
62 21. Tax paid on Form OR-OC filed on owner’s behalf .........................................................................21. 99,999,999,999.00.00 62
63 Keep this schedule with your tax records. Don’t submit with your individual tax return or the PTE return. 63
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