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Oregon Department of Revenue
5 Form OR-706-V 5
6 Oregon Estate Transfer Tax 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 Date of death (MM/DD/YYYY) 9
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11 99/99/9999/ / 11
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13 Decedent first name Initial 13
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XXXXXXXXXXXXXXXX X
16 Decedent last name 16
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
19 Decedent Social Security number (DSSN) 19
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999-99-9999
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23 Executor first name Initial Executor last name 23
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XXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
26 Executor address 26
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
29 City State ZIP code 29
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XXXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX
32 Executor phone 32
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999-999-9999
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46 Payment type (check one) 46
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48 X Original return 48
49 Use this voucher only if you’re sending a payment separate from a return. Make 49
50 your check, money order, or cashier’s check payable to the Oregon Department of Prepayment 50
51 Revenue. Write “Form OR-706-V,” the Decedent name, the DSSN, the date of death, X 51
and a daytime phone for the executor on your payment. Don’t mail cash. Mail the
52 voucher and payment to: X Amended return 52
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54 Oregon Department of Revenue 54
PO Box 14950
55 Salem OR 97309-0950 55
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57 Enter payment amount 57
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59 150-104-172 59
(Rev. 05-10-22, ver. 03)
60 9999 99 $ , 99,999,999.00, 0 0 60
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63 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 63
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