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5                                                                                                                  Oregon Department of Revenue                               5
                  2022 Form OR-20-INS
6                 Oregon Insurance Excise Tax Return                                                                                                                          6
7                                                                                                                                                                             7
8                 Page 1 of 7           • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           8
9           Short year beginning (MM/DD/YYYY)             Short year ending (MM/DD/YYYY)                                                                                      9
10                                                                                                                                                                            10
11          99/99/9999/              /                    99/99/9999/      /                                                                                                  11
12                                                                                                                                                                            12
13          See instructions for checkboxes.                                                                                                                                  13
14                                                                                                                                                                            14
15          X     New name                       X        New address             X          Extension                    X Form OR-37                                        15
16                                                                                                                                                                            16
17          X     Amended                        X        Alternative apportionment request included                                                                          17
18                                                                                                                                                                            18
19          Corporation legal name                                                                                                                                            19
20                                                                                                                                                                            20
21                                                                                                                                                                            21
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
22          Federal employer identification number (FEIN)                                                                                                                     22
23                                                                                                                                                                            23
24                                                                                                                                                                            24
            99-9999999
25          Doing business as (DBA) or assumed business name (ABN)                                                                                                            25
26                                                                                                                                                                            26
27                                                                                                                                                                            27
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
28          Attn: or c/o, first name                               Initial Attn: or c/o, last name                                                                            28
29                                                                                                                                                                            29
30                                                                                                                                                                            30
            XXXXXXXXXXXXXXXX                                       X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
31          Corporation current address                                                                                                                                       31
32                                                                                                                                                                            32
33                                                                                                                                                                            33
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
34          City                                                                                       State       ZIP code                                                   34
35                                                                                                                                                                            35
36          XXXXXXXXXXXXXXXXXXXXXX                                                                     XX          XXXXX-XXXX -                                               36
37                                                                                                                                                                            37
38          Contact first name                                     Initial Contact last name                                                                                  38
39                                                                                                                                                                            39
40                                                                                                                                                                            40
            XXXXXXXXXXXXXXXX                                       X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
41          Contact phone                                                                                                                                                     41
42                                                                                                                                                                            42
43                                                                                                                                                                            43
            999-999-9999
44          Email                                                                                                                                                             44
45                                                                                                                                                                            45
46                                                                                                                                                                            46
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
47                                                                                                                                                                            47
48          Only complete questions A through C if this is your first return, or the answer changed during this tax year.                                                     48
49                                                                                                                                                                            49
50          A. Incorporated in (state)        Incorporated on (date) (MM/DD/YYYY)                                                                                             50
51                                                                                                                                                                            51
52          XX                                99/99/9999/          /                                                                                                          52
53          B. State of commercial domicile   C. Date business activity began in Oregon (MM/DD/YYYY) D. NAICS code                                                            53
54                                                                                                                                                                            54
55          XX                                99/99/9999/          /                                         999999                                                           55
56                                                                                                                                                                            56
57                                                                                                                              Continued on next page                        57
58                                                                                                                                                                            58
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60                                                                                                                                                                            60
61                                                                                                                                                                            61
62                                                                                                                                                                            62
                  150-102-129
63                (Rev. 08-04-22, ver. 01)                                                                         02932201010000                                             63
64                                                                                                                                                                            64
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66                                                                                                                                                                            66

67                                                                                                                                                                                     67
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69                                                                                                                                                                                     69
70                                                                                                                                                                                     70
71                        2022 Form OR-20-INS                                                                                              Oregon Department of Revenue                71
72                                                                                                                                                                                     72
73                                                                                                                                                                                     73
74                        Page 2 of 7      • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.                 74
75                                                                                                                                                                                     75
76           E.   X       (1) Consolidated federal return X       (2) Consolidated Oregon return                    X (3) Corporations included in consolidated federal                76
77                                                                                                                    return, but not in Oregon return                                 77
78                                                                                                                                                                                     78
79           F. Parent corporation name, if applicable                                                                                                                                 79
80                                                                                                                                                                                     80
81                                                                                                                                                                                     81
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
82              Parent corporation FEIN, if applicable          G. Number of Oregon corporations                                                                                       82
83                                                                                                                                                                                     83
84                                                                                                                                                                                     84
                99-9999999                                          999
85                                                                                                                                                                                     85
86                                                                                                                                                                                     86
87           H. List the tax years for which federal waivers of the statute of limitations are in effect and dates on which waivers expire                                             87
88                                                                                                                                                                                     88
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
89                                                                                                                                                                                     89
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
90                                                                                                                                                                                     90
91           I. List the tax years for which your federal taxable income was changed by an IRS audit or by an amended federal return filed during this tax year                        91
92                                                                                                                                                                                     92
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
93                                                                                                                                                                                     93
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
94                                                                                                                                                                                     94
95                                                                                                                                                                                     95
96           J. If first return, indicate: X New business         X Successor to previous business                                                                                     96
97                                                                                                                                                                                     97
98              Previous business name                                                                                                                                                 98
99                                                                                                                                                                                     99
100                                                                                                                                                                                    100
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
101             FEIN                                                                                                                                                                   101
102                                                                                                                                                                                    102
103                                                                                                                                                                                    103
                99-9999999
104                                                                                                                                                                                    104
105          K. If final return, indicate: X Withdrawn            X Dissolved                                    X  Merged or reorganized                                              105
106                                                                                                                                                                                    106
107             Merged or reorganized corporation name                                                                                                                                 107
108                                                                                                                                                                                    108
109                                                                                                                                                                                    109
                XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
110             FEIN                                                                                                                                                                   110
111                                                                                                                                                                                    111
112                                                                                                                                                                                    112
                99-9999999
113                                                                                                                                                                                    113
114                                                                                                                                                                                    114
115                                                                                                                                                                                    115
116          L.   Fill in the amount of your total Oregon sales .................................................L. ,                      , 99,999,999,999.00,         0 0            116
117                                                                                                                                                                                    117
118                                                                                                                                                                                    118
119                                                                                                                                                                                    119
120                                                                                                                                                                                    120
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128                                                                                                                                                                                    128
                          150-102-129
129                       (Rev. 08-04-22, ver. 01)                                                                                         02932201020000                              129
130                                                                                                                                                                                    130
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132                                                                                                                                                                                    132

133                                                                                                                                                                        133
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135                                                                                                                                                                        135
136                                                                                                                                                                        136
137                      2022 Form OR-20-INS                                                                                      Oregon Department of Revenue             137
138                                                                                                                                                                        138
139                                                                                                                                                                        139
140                      Page 3 of 7       • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     140
141                                                                                                                                                                        141
142          Income—Net income from the annual statement to the insurance commissioner:                                                                                    142
143                                                                                                                                                                        143
144            1.  Life, accident, and health companies (from page 4, line 35 of the                                                                                       144
145                 annual statement) ....................................................................................1.    , , 99,999,999,999.00,                 0 0 145
146            2.  Less: Income, expenses, and other items attributable to separate                                                                                        146
147                 accounts (from ‘Summary of Operations,’ page 4, lines 5 & 8.1 of the                                                                                   147
148                 annual statement for life companies) .......................................................2.              , , 99,999,999,999.00,                 0 0 148
149                                                                                                                                                                        149
150                                                                                                                                                                        150
151            3.  Subtotal (line 1 minus line 2) ....................................................................3.        , , 99,999,999,999.00,                 0 0 151
152                                                                                                                                                                        152
153            4.  Fire, property, and casualty companies (from page 4, line 20 of the                                                                                     153
154                 annual statement) ....................................................................................4.    , , 99,999,999,999.00,                 0 0 154
155                                                                                                                                                                        155
156            5.  Less: Underwriting profit derived from wet marine and                                                                                                   156
157                 transportation insurance ..........................................................................5.       , , 99,999,999,999.00,                 0 0 157
158                                                                                                                                                                        158
159                                                                                                                                                                        159
160            6.  Subtotal (line 4 minus line 5) ....................................................................6.        , , 99,999,999,999.00,                 0 0 160
161                                                                                                                                                                        161
162                                                                                                                                                                        162
163            7.  Total (line 3 plus line 6) .............................................................................7.   , , 99,999,999,999.00,                 0 0 163
164                                                                                                                                                                        164
165            8.  Total additions from Schedule OR-ASC-CORP, Section A                                                                                                    165
166                 (see instructions) ......................................................................................8. , , 99,999,999,999.00,                 0 0 166
167                                                                                                                                                                        167
168                                                                                                                                                                        168
169            9.  Income after additions (line 7 plus line 8) ................................................9.               , , 99,999,999,999.00,                 0 0 169
170                                                                                                                                                                        170
171            10.  Total subtractions from Schedule OR-ASC-CORP, Section B                                                                                                171
172                 (see instructions) ....................................................................................10.  , , 99,999,999,999.00,                 0 0 172
173            11.  Income before net loss deduction (line 9 minus line 10). If income is                                                                                  173
174                 derived from sources both in Oregon and other states, carry                                                                                            174
175              amount on line 11 to Schedule OR-AP, part 2, line 1. Complete                                                                                             175
176                 both parts of Schedule OR-AP ...........................................................11.                 , , 99,999,999,999.00,                 0 0 176
177                                                                                                                                                                        177
178                                                                                                                                                                        178
179            12.  Net loss deduction (include schedule, enter as a positive number) ......12.                                 , , 99,999,999,999.00,                 0 0 179
180            13.  Enter the apportionment percentage from Schedule OR-AP, part 1,                                                                                        180
181                 line 23. Enter 100.0000 if you don’t apportion income.                                                                                                 181
182                 You must include Schedule OR-AP to apportion income ................13.                                       999.9999 %                               182
183                                                                                                                                                                        183
184            14.  Oregon taxable income (line 11 minus line 12, or amount Schedule                                                                                       184
185                 OR-AP, part 2, line 12) ............................................................................14.     , , 99,999,999,999.00,                 0 0 185
186                                                                                                                                                                        186
187                                                                                                                                                                        187
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189                                                                                                                                          Continued on next page        189
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194                                                                                                                                                                        194
                         150-102-129
195                      (Rev. 08-04-22, ver. 01)                                                                                 02932201030000                           195
196                                                                                                                                                                        196
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198                                                                                                                                                                        198

199                                                                                                                                                                       199
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201                                                                                                                                                                       201
202                                                                                                                                                                       202
203                        2022 Form OR-20-INS                                                                                     Oregon Department of Revenue           203
204                                                                                                                                                                       204
205                                                                                                                                                                       205
206                        Page 4 of 7    • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     206
207                                                                                                                                                                       207
208          Tax                                                                                                                                                          208
209            15.  Calculated excise tax (see instructions) .................................................15.                , , 99,999,999,999.00,               0 0 209
210                                                                                                                                                                       210
211                                                                                                                                                                       211
212            16.  Minimum tax (based on Oregon sales, see instructions) .......................16.                             , , 99,999,999,999.00,               0 0 212
213                                                                                                                                                                       213
214                                                                                                                                                                       214
215            17.  Tax (greater of line 15 or line 16) ............................................................17.          , , 99,999,999,999.00,               0 0 215
216                                                                                                                                                                       216
217                                                                                                                                                                       217
218            18.  Tax adjustment for installment sales interest (include schedule) ...........18.                              , , 99,999,999,999.00,               0 0 218
219                                                                                                                                                                       219
220                                                                                                                                                                       220
221            19.  Tax before credits (line 17 plus line 18) ..................................................19.              , , 99,999,999,999.00,               0 0 221
222                                                                                                                                                                       222
223                                                                                                                                                                       223
224          Credits                                                                                                                                                      224
225            20.  Total standard credits from Schedule OR-ASC-CORP, Section C.........20.                                      , , 99,999,999,999.00,               0 0 225
226                                                                                                                                                                       226
227            21.  Tax after standard credits (line 19 minus line 20, not less than                                                                                      227
228                 minimum tax) .........................................................................................21.    , , 99,999,999,999.00,               0 0 228
229                                                                                                                                                                       229
230            22.  Total carryforward credits from Schedule OR-ASC-CORP,                                                                                                 230
231                 Section D ...............................................................................................22. , , 99,999,999,999.00,               0 0 231
232                                                                                                                                                                       232
233                                                                                                                                                                       233
234            23.  OLHIGA (Oregon Life and Health Insurance Guaranty Association) ......23.                                     , , 99,999,999,999.00,               0 0 234
235                                                                                                                                                                       235
236                                                                                                                                                                       236
237            24.  Total carryforward credits/offsets (add lines 22 through 23) ..................24.                           , , 99,999,999,999.00,               0 0 237
238                                                                                                                                                                       238
239                                                                                                                                                                       239
240          Excise tax                                                                                                                                                   240
241            25.  Net excise tax (line 21 minus line 24, not below minimum tax;                                                                                         241
242                 see instructions) .....................................................................................25.   , , 99,999,999,999.00,               0 0 242
243            26.  Estimated tax payments, other prepayments, and refundable                                                                                             243
244                 credits from Schedule ES, line 8. Include payments made with                                                                                          244
245                 your extension........................................................................................26.    , , 99,999,999,999.00,               0 0 245
246                                                                                                                                                                       246
247            27.  Withholding payments made on your behalf from pass-through                                                                                            247
248                 entity or real estate income (include schedule) ......................................27.                    , , 99,999,999,999.00,               0 0 248
249                                                                                                                                                                       249
250            28.  Tax due. Is line 25 more than line 26 plus line 27? If so, line 25                                                                                    250
251                 minus lines 26 and 27 .............................................................Tax due  28.              , , 99,999,999,999.00,               0 0 251
252                                                                                                                                                                       252
253            29.  Overpayment. Is line 25 less than line 26 plus line 27?                                                                                               253
254                 If so, line 26 plus line 27, minus line 25 ........................Overpayment  29.                          , , 99,999,999,999.00,               0 0 254
255                                                                                                                                                                       255
256                                                                                                                                  Continued on next page               256
257                                                                                                                                                                       257
258                                                                                                                                                                       258
259                                                                                                                                                                       259
260                                                                                                                                                                       260
                           150-102-129
261                        (Rev. 08-04-22, ver. 01)                                                                                02932201040000                         261
262                                                                                                                                                                       262
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264                                                                                                                                                                       264

265                                                                                                                                                                     265
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267                                                                                                                                                                     267
268                                                                                                                                                                     268
269                       2022 Form OR-20-INS                                                                                   Oregon Department of Revenue            269
270                                                                                                                                                                     270
271                                                                                                                                                                     271
272                       Page 5 of 7   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     272
273                                                                                                                                                                     273
274                                                                                                                                                                     274
275            30.  Penalty due with this return ...................................................................30.       , , 99,999,999,999.00,                0 0 275
276                                                                                                                                                                     276
277                                                                                                                                                                     277
278            31.  Interest due with this return ...................................................................31.      , , 99,999,999,999.00,                0 0 278
279                                                                                                                                                                     279
280                                                                                                                                                                     280
281            32.  Interest on underpayment of estimated tax (include Form OR-37) .......32.                                 , , 99,999,999,999.00,                0 0 281
282                                                                                                                                                                     282
283                                                                                                                                                                     283
284            33.  Total penalty and interest (add lines 30 through 32) ...............................33.                   , , 99,999,999,999.00,                0 0 284
285                                                                                                                                                                     285
286                                                                                                                                                                     286
287            34.  Total due (line 28 plus line 33) .............................................Total due  34.              , , 99,999,999,999.00,                0 0 287
288                                                                                                                                                                     288
289                                                                                                                                                                     289
290            35.  Refund available (line 29 minus line 33) ..................................Refund  35.                    , , 99,999,999,999.00,                0 0 290
291                                                                                                                                                                     291
292                                                                                                                                                                     292
293            36.  Amount of refund to be credited to your open estimated tax account ...36.                                 , , 99,999,999,999.00,                0 0 293
294                                                                                                                                                                     294
295                                                                                                                                                                     295
296            37.  Net refund (line 35 minus line 36) .....................................Net refund  37.                   , , 99,999,999,999.00,                0 0 296
297                                                                                                                                                                     297
298                                                                                                                                                                     298
299          Schedule ES—Estimated tax payments, other prepayments, and refundable credits                                                                              299
300          1. Quarter 1                                                                                                                                               300
301          Payer name                                                                                                                                                 301
302                                                                                                                                                                     302
303                                                                                                                                                                     303
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
304          Payer FEIN                                      Date paid                                                                                                  304
305                                                                                                                                                                     305
306          99-9999999                                      99/99/9999/                          /                                                                     306
307                                                                                                                                                                     307
308                                                                                                                                                                     308
309            1.  Amount paid.............................................................................................1. , , 99,999,999,999.00,                0 0 309
310                                                                                                                                                                     310
311                                                                                                                                                                     311
312          2. Quarter 2                                                                                                                                               312
313          Payer name                                                                                                                                                 313
314                                                                                                                                                                     314
315                                                                                                                                                                     315
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
316          Payer FEIN                                      Date paid                                                                                                  316
317                                                                                                                                                                     317
318          99-9999999                                      99/99/9999/                          /                                                                     318
319                                                                                                                                                                     319
320                                                                                                                                                                     320
321            2.  Amount paid.............................................................................................2. , , 99,999,999,999.00,                0 0 321
322                                                                                                                                                                     322
323                                                                                                                               Continued on next page                323
324                                                                                                                                                                     324
325                                                                                                                                                                     325
326                                                                                                                                                                     326
                          150-102-129
327                       (Rev. 08-04-22, ver. 01)                                                                              02932201050000                          327
328                                                                                                                                                                     328
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330                                                                                                                                                                     330

331                                                                                                                                                                   331
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333                                                                                                                                                                   333
334                                                                                                                                                                   334
335                      2022 Form OR-20-INS                                                                                         Oregon Department of Revenue     335
336                                                                                                                                                                   336
337                                                                                                                                                                   337
338                      Page 6 of 7  • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.     338
339                                                                                                                                                                   339
340          3. Quarter 3                                                                                                                                             340
341          Payer name                                                                                                                                               341
342                                                                                                                                                                   342
343                                                                                                                                                                   343
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
344          Payer FEIN                                  Date paid                                                                                                    344
345                                                                                                                                                                   345
346          99-9999999                                  99/99/9999/          /                                                                                       346
347                                                                                                                                                                   347
348                                                                                                                                                                   348
349            3.  Amount paid.............................................................................................3.      , , 99,999,999,999.00,         0 0 349
350                                                                                                                                                                   350
351                                                                                                                                                                   351
352          4. Quarter 4                                                                                                                                             352
353          Payer name                                                                                                                                               353
354                                                                                                                                                                   354
355                                                                                                                                                                   355
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
356          Payer FEIN                                  Date paid                                                                                                    356
357                                                                                                                                                                   357
358          99-9999999                                  99/99/9999/          /                                                                                       358
359                                                                                                                                                                   359
360                                                                                                                                                                   360
361            4.  Amount paid.............................................................................................4.      , , 99,999,999,999.00,         0 0 361
362                                                                                                                                                                   362
363                                                                                                                                                                   363
364            5.  Overpayment of another year’s tax applied as a credit against this                                                                                 364
365                year’s tax ..................................................................................................5. , , 99,999,999,999.00,         0 0 365
366                                                                                                                                                                   366
367                                                                                                                                                                   367
368            6.  Payments made with extension or other prepayments for this tax year ...6.                                       , , 99,999,999,999.00,         0 0 368
369                Date paid (MM/DD/YYYY)                                                                                                                             369
370                                                                                                                                                                   370
371                99/99/9999/        /                                                                                                                               371
372                                                                                                                                                                   372
373            7.  Refundable credits from Schedule OR-ASC-CORP, Section E ...............7.                                       , , 99,999,999,999.00,         0 0 373
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375                                                                                                                                                                   375
376            8.  Total prepayments and refundable credits (carry to line 26 above) .........8.                                   , , 99,999,999,999.00,         0 0 376
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                         150-102-129
393                      (Rev. 08-04-22, ver. 01)                                                                                    02932201060000                   393
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401                        2022 Form OR-20-INS                                                       Oregon Department of Revenue                                  401
402                                                                                                                                                                402
403                                                                                                                                                                403
404                        Page 7 of 7 • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples. 404
405                                                                                                                                                                405
406          Under penalty of false swearing, I declare that the information in this return and any enclosures are true, correct, and complete.                    406
407          Officer signature                                                                                                                                     407
408                                                                                                                                                                408
409          X                                                                                                                                                     409
410          Date (MM/DD/YYYY)                                                                                                                                     410
411                                                                                                                                                                411
412          99/99/9999/         /                                                                                                                                 412
413          Officer first name                             Initial Officer last name                                                                              413
414                                                                                                                                                                414
415                                                                                                                                                                415
             XXXXXXXXXXXXXXXX                               X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
416          Officer title                                                                                                                                         416
417                                                                                                                                                                417
418                                                                                                                                                                418
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
419                                                                                                                                                                419
420          Preparer signature other than taxpayer                                                                                                                420
421                                                                                                                                                                421
422          X                                                                                                                                                     422
423          Date (MM/DD/YYYY)                      Phone                                    Preparer license number                                               423
424                                                                                                                                                                424
425          99/99/9999/         /                  999-999-9999                             XXXXXXXXXX                                                            425
426          Preparer first name                            Initial Preparer last name                                                                             426
427                                                                                                                                                                427
428                                                                                                                                                                428
             XXXXXXXXXXXXXXXX                               X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
429          Preparer address                                                                                                                                      429
430                                                                                                                                                                430
431                                                                                                                                                                431
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
432          City                                                                      State         ZIP code                                                      432
433                                                                                                                                                                433
434          XXXXXXXXXXXXXXXXXXXXXX                                                    XX            XXXXX-XXXX -                                                  434
435                                                                                                                                                                435
436                                                                                                                                                                436
437          Mail refund returns and no tax due returns to: Mail tax-to-pay returns with payment to:                                                               437
438          Refund, PO Box 14777, Salem OR 97309-0960      Oregon Department of Revenue, PO Box 14790, Salem OR 97309-0470                                        438
439          Do not include a payment voucher with your return. Include Oregon schedules and file with the Oregon Department of Revenue.                           439
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                           150-102-129
459                        (Rev. 08-04-22, ver. 01)                                                  02932201070000                                                459
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