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5 Oregon Department of Revenue 5
2022 Form OR-10
6 Underpayment of Oregon Estimated Tax 6
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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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Instructions: Use this form to report the interest on underpaid estimated tax or to claim an exception to paying estimated tax. Figure
11 your required installment payments and total underpayment interest using the worksheets inside Form OR-10 Instructions. 11
12 If you’re claiming an exception or owe underpayment interest, include this form when you file your Oregon return. 12
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14 Last name 14
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XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
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18 Social Security number (SSN) 18
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999-99-9999
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Exception
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24 1. If you qualify for an exception to the imposition of underpayment 24
25 interest, enter the exception number here and on Form OR-40, 25
26 box 43a; Form OR-40-N, box 68a; or Form OR-40-P, box 67a ...............1. 9 26
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Required annual payment
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30 2. Enter the amount from line 10 of the Required annual payment 30
31 worksheet inside Form OR-10 Instructions. ............................................2. , , 99,999,999,999.00, 0 0 31
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33 Required installment payments 33
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35 3. Enter the amounts for each installment period from lines 1, 6, 11, and 17 35
36 of the Underpayment interest worksheet inside Form OR-10 Instructions. 36
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38 3A. Installment payment 1: due April 18, 2022.....................................3A. , , 99,999,999,999.00, 0 0 38
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41 3B. Installment payment 2: due June 15, 2022 .................................... 3B. , , 99,999,999,999.00, 0 0 41
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44 3C. Installment payment 3: due September 15, 2022 .......................... 3C. , , 99,999,999,999.00, 0 0 44
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47 3D. Installment payment 4: due January 17, 2023 ............................... 3D. , , 99,999,999,999.00, 0 0 47
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50 Total underpayment interest for tax year 2022 50
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52 4. Enter the amount from line 22 of the Underpayment interest worksheet 52
53 inside Form OR-10 Instructions here and on Form OR-40, line 43; Form 53
54 OR-40-N, line 68; or Form OR-40-P, line 67 ...................................Total 4. , , 99,999,999,999.00, 0 0 54
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59 —You must include this form with your Oregon income tax return— 59
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150-101-031
63 (Rev. 08-09-22, ver. 01) 00402201010000 63
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