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3 3
4 4
5 2022 Schedule OR-OC-4 Office use only 5
6 Page 1 of 1, 150-101-149 Oregon Department of Revenue 20722201010000 6
7 (Rev. 09-08-22 ver. 01) 7
8 CPAR Adjustments Report for C Corporation Owners 8
9 9
10 10
11 Submit original form—do not submit photocopy. 11
12 Pass-through entity name Federal employer identification number (FEIN) 12
13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 13
14 Owner information (see instructions) 14
15 1. Corporation name FEIN Ownership percentage 15
16 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 999.9999. % 16
17 Share of federal CPAR adjustments 17
18 18
99,999,999,999.00.00
19 19
20 Share of Oregon-source CPAR adjustments (a) CPAR tax 20
21 21
99,999,999,999.00.00 99,999,999,999.00.00
22 22
23 2. Corporation name FEIN Ownership percentage 23
24 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 999.9999. % 24
25 Share of federal CPAR adjustments 25
26 26
99,999,999,999.00.00
27 27
28 Share of Oregon-source CPAR adjustments (a) CPAR tax 28
29 29
99,999,999,999.00.00 99,999,999,999.00.00
30 30
31 3. Corporation name FEIN Ownership percentage 31
32 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 999.9999. % 32
33 Share of federal CPAR adjustments 33
34 34
99,999,999,999.00.00
35 35
36 Share of Oregon-source CPAR adjustments (a) CPAR tax 36
37 37
99,999,999,999.00.00 99,999,999,999.00.00
38 38
39 4. Corporation name FEIN Ownership percentage 39
40 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 999.9999. % 40
41 Share of federal CPAR adjustments 41
42 42
99,999,999,999.00.00
43 43
44 Share of Oregon-source CPAR adjustments (a) CPAR tax 44
45 45
99,999,999,999.00.00 99,999,999,999.00.00
46 46
47 5. Corporation name FEIN Ownership percentage 47
48 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 99-9999999– 999.9999. % 48
49 Share of federal CPAR adjustments 49
50 50
99,999,999,999.00.00
51 51
52 Share of Oregon-source CPAR adjustments (a) CPAR tax 52
53 53
99,999,999,999.00.00 99,999,999,999.00.00
54 54
55 Total column (a) 55
56 6. Total CPAR tax 56
99,999,999,999.00.00
57 57
58 58
59 59
60 60
61 Include this schedule with your Form OR-OC . 61
62 Use additional copies of this page for additional C corporations. 62
63 If using more than one page, total all pages on line 6 of the first page. Page ______ 999 of 999_______ 63
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66 66