1 1
1 2 2 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 Form All layers With grid &2 data 84 85
3 4 82 83
3 3
4 4
Oregon Department of Revenue
5 Form OR-CAT-V 5
6 Oregon Corporate Activity 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 Tax year begins (MM/DD/YYYY) Tax year ends (MM/DD/YYYY) 9
10 10
11 99/99/9999/ / 99/99/9999/ / 11
12 12
13 Legal name of designated CAT entity (sole proprietor—complete First name and Last name lines below) 13
14 14
15 15
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16 Federal employer identification number (FEIN) 16
17 17
18 18
99-9999999
19 19
20 First name Initial 20
21 21
22 22
XXXXXXXXXXXXXXXX X
23 Last name 23
24 24
25 25
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
26 Social Security number (SSN) 26
27 27
28 28
999-99-9999
29 29
30 Designated CAT entity address 30
31 31
32 32
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
33 City State ZIP code 33
34 34
35 XXXXXXXXXXXXXXXXXXXXXX XX XXXXX-XXXX - 35
36 Country (if other than U.S.) 36
37 37
38 38
XXXXXXXXXXXXXXXXXXXXX
39 39
40 Contact first name Initial Contact last name 40
41 41
42 42
XXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
43 Contact phone 43
44 44
45 45
999-999-9999
46 Payment type (check one) 46
47 47
48 X Original return 48
49 49
50 X Estimated payment 50
51 51
52 Mail your payment to: X Amended return 52
53 53
54 Oregon Department of Revenue 54
PO Box 14950
55 Salem OR 97309-0950 55
56 56
57 Enter payment amount 57
58 58
59 150-106-172 59
(Rev. 06-29-21, ver. 04)
60 $ , 99,999,999.00, 0 0 60
61 61
62 62
63 63
64 64
1 2 65 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 65 84 85
3 4 82 83
66 66