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5 Oregon Department of Revenue 5
2022 Schedule OR-EXC-CAT
6 Exclusions From Commercial Activity 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
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10 Legal name of designated Corporate Activity Tax (CAT) entity (sole proprietor—complete the next line) 10
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
13 First name (if sole proprietorship) Initial Last name 13
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XXXXXXXXXXXXXXXX X XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
16 Federal employer identification number (FEIN) Social Security number (SSN) 16
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99-9999999 999-99-9999
19 19
20 Use this form to report exclusions from commercial activity on your Oregon Corporate Activity Tax Return. Use codes from Appendix 20
21 A from the 2022 Form OR-CAT instructions. If you have more items than will fit on a single schedule, provide the codes and amounts 21
22 on additional schedules and add the total to your tax return. Include all the schedules with your return. 22
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25 Exclusions from commercial activity 25
26 Code Amount 26
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28 1. 999 2. , , 99,999,999,999.00, 0 0 28
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31 3. 999 4. , , 99,999,999,999.00, 0 0 31
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34 5. 999 6. , , 99,999,999,999.00, 0 0 34
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37 7. 999 8. , , 99,999,999,999.00, 0 0 37
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40 9. 999 10. , , 99,999,999,999.00, 0 0 40
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43 11. 999 12. , , 99,999,999,999.00, 0 0 43
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46 13. 999 14. , , 99,999,999,999.00, 0 0 46
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49 15. 999 16. , , 99,999,999,999.00, 0 0 49
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52 17. 999 18. , , 99,999,999,999.00, 0 0 52
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55 Total , , 99,999,999,999.00, 0 0 55
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57 Enter total on Form OR-CAT, line 2 57
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59 You must include this schedule with your Oregon Corporate Activity Tax Return if you are claiming any exclusions from commercial activity. 59
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150-106-004
63 (Rev. 06-10-22, ver. 01) 20542201010000 63
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