1                                                                                                                                                                         1
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3                                                                                                                                                                         3
4                                                                                                                                                                         4
                                                                                                                   Oregon Department of Revenue
5                      2022 Form OR-40                                                                                                                                    5
6                      Oregon Individual Income Tax Return for Full-year Residents                                                                                        6
7                                                                                                                                                                         7
8                      Page 1 of 8  • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           8
9           Fiscal year ending date (MM/DD/YYYY)                                       Space for 2-D barcode—do not write in box below                                    9
10                                                           X Extension filed                                                                                            10
11          99/99/9999/       /                                                                                                                                           11
12                                                           X Form OR-24                                                                                                 12
13          X      Amended return.                                                                                                                                        13
14               If amending for an      NOL tax year (YYYY) X Form OR-243                                                                                                14
15               NOL, tax year the                                                                                                                                        15
16               NOL was generated:             9999         X Federal Form 8379                                                                                          16
17                                                                                                                                                                        17
18          X    Calculated with “as if” federal return      X Federal Form 8886                                                                                          18
19                                                                                                                                                                        19
20          X    Short-year tax election                     X Disaster relief                                                                                            20
21                                                                                                                                                                        21
22                                                                                                                                                                        22
23                                                                                                                                                                        23
24          First name                                                         Initial Date of birth (MM/DD/YYYY)                                                         24
25                                                                                                                                                                        25
26          XXXXXXXXXXXXXXXX                                                   X       99/99/9999/          /                                                             26
27          Last name                                                                                                                                                     27
28                                                                                                                                                                        28
29                                                                                                                                                                        29
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
30          Social Security number (SSN)                                                                                                                                  30
31                                                                                                                                                                        31
32          999-99-9999                                      X First time using this SSN (see instructions)        X Applied for ITIN             X             Deceased  32
33                                                                                                                                                                        33
34          Spouse first name                                                  Initial Spouse date of birth (MM/DD/YYYY)                                                  34
35                                                                                                                                                                        35
36          XXXXXXXXXXXXXXXX                                                   X       99/99/9999/          /                                                             36
37          Spouse last name                                                                                                                                              37
38                                                                                                                                                                        38
39                                                                                                                                                                        39
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
40          Spouse SSN                                                                                                                                                    40
41                                                                                                                                                                        41
42          999-99-9999                                      X First time using this SSN (see instructions)        X Applied for ITIN             X             Deceased  42
43                                                                                                                                                                        43
44          Current address                                                                                                                                               44
45                                                                                                                                                                        45
46                                                                                                                                                                        46
            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
47          City                                                                       State                       ZIP code                                               47
48                                                                                                                                                                        48
49                                                                                                                                                                        49
            XXXXXXXXXXXXXXXXXXXXXX                                                     XX                          XXXXX-XXXX
50          Country                                                                    Phone                                                                              50
51                                                                                                                                                                        51
52                                                                                                                                                                        52
            XXXXXXXXXXXXXXXXXXXXX                                                      999-999-9999
53                                                                                                                                                                        53
54          Filing Status (check only one box)                                                                                                                            54
55                                                                                                                                                                        55
56          1.   X     Single            2. X    Married filing jointly 3.     X       Married filing separately (enter spouse’s information above)                       56
57                                                                                                                                                                        57
58          4.   X     Head of household (with qualifying dependent)    5.     X       Qualifying surviving spouse                                                        58
59                                                                                                                                                                        59
60                                                                                                                                                                        60
61                                                                                                                                                                        61
62                                                                                                                                                                        62
                       150-101-040
63                     (Rev. 09-12-22, ver. 01)                                                                      00462201010000                                       63
64                                                                                                                                                                        64
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66                                                                                                                                                                        66

67                                                                                                                                                                                                                                       67
  1  2   68   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   68   84 85
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69                                                                                                                                                                                                                                       69
70                                                                                                                                                                                                                                       70
                                                                                                    Oregon Department of Revenue
71                     2022 Form OR-40                                                                                                                                                                                                   71
72                                                                                                                                                                                                                                       72
73                                                                                                                                                                                                                                       73
74                     Page 2 of 8   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.                                                                         74
75           Last name                                                                       SSN                                                                                                                                         75
76                                                                                                                                                                                                                                       76
77                                                                                                                                                                                                                                       77
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                999-99-9999
78                                                                                                                                                                                                                                       78
79           Note: Reprint page 1 if you make changes to this page.                                                                                                                                                                      79
80                                                                                                                                                                                                                                       80
81           Exemptions                                                                                                                                                                                                                  81
82             6a.  Credits for yourself .........................................................................................................................................................................................6a. 9  82
83                                                                                                                                                                                                                                       83
84             Check boxes that apply:          X    Regular  X       Severely disabled X    Someone else can claim you as a dependent                                                                                                   84
85                                                                                                                                                                                                                                       85
86             6b.  Credits for your spouse .................................................................................................................................................................................6b.      9  86
87                                                                                                                                                                                                                                       87
88             Check boxes that apply:          X    Regular  X       Severely disabled X    Someone else can claim you as a dependent                                                                                                   88
89                                                                                                                                                                                                                                       89
90           Dependents.                                                                                                                                                                                                                 90
91           List your dependents in order from youngest to oldest.                                                                                                                                                                      91
92                                                                                                                                                                                                                                       92
93           Dependent 1: First name                          Initial Dependent 1: Last name                                                                                                                                             93
94                                                                                                                                                                                                                                       94
95                                                                                                                                                                                                                                       95
             XXXXXXXXXXXXXXXX                                 X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
96           Dependent 1: Date of birth (MM/DD/YYYY) Dependent 1: SSN                        Code *                                                                                                                                      96
97                                                                                                      Dependent 1: Check if child                                                                                                      97
98           99/99/9999/           /                 999-99-9999                             XX     X   has a qualifying disability                                                                                                      98
99                                                                                                                                                                                                                                       99
100          Dependent 2: First name                          Initial Dependent 2: Last name                                                                                                                                             100
101                                                                                                                                                                                                                                      101
102                                                                                                                                                                                                                                      102
             XXXXXXXXXXXXXXXX                                 X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
103          Dependent 2: Date of birth (MM/DD/YYYY) Dependent 2: SSN                        Code *                                                                                                                                      103
104                                                                                                     Dependent 2: Check if child                                                                                                      104
105          99/99/9999/           /                 999-99-9999                             XX     X   has a qualifying disability                                                                                                      105
106                                                                                                                                                                                                                                      106
107          Dependent 3: First name                          Initial Dependent 3: Last name                                                                                                                                             107
108                                                                                                                                                                                                                                      108
109                                                                                                                                                                                                                                      109
             XXXXXXXXXXXXXXXX                                 X       XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
110          Dependent 3: Date of birth (MM/DD/YYYY) Dependent 3: SSN                        Code *                                                                                                                                      110
111                                                                                                     Dependent 3: Check if child                                                                                                      111
112          99/99/9999/           /                 999-99-9999                             XX     X   has a qualifying disability                                                                                                      112
113                                                                                                                                                                                                                                      113
114          *Dependent relationship code (see instructions).                                                                                                                                                                            114
115                                                                                                                                                                                                                                      115
116            6c.  Total number of dependents ..................................................................................................................................................................6c.                  99 116
117                                                                                                                                                                                                                                      117
118                                                                                                                                                                                                                                      118
119            6d.  Total number of dependent children with a qualifying disability (see instructions) ................................................................................6d.                                            99 119
120                                                                                                                                                                                                                                      120
121                                                                                                                                                                                                                                      121
122            6e.  Total exemptions. Add lines 6a through 6d.................................................................................................................................. Total 6e.                             99 122
123                                                                                                                                                                                                                                      123
124                                                                                                                                                                                                                                      124
125                                                                                                                                                                                                                                      125
126                                                                                                                                                                                                                                      126
127                                                                                                                                                                                                                                      127
128                                                                                                                                                                                                                                      128
                       150-101-040
129                    (Rev. 09-12-22, ver. 01)                                                     00462201020000                                                                                                                       129
130                                                                                                                                                                                                                                      130
  1  2   131   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   131   84 85
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132                                                                                                                                                                                                                                      132

133                                                                                                                                                                           133
  1  2   134   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   134   84 85
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135                                                                                                                                                                           135
136                                                                                                                                                                           136
137                                                                                                                                                                           137
                                                                                                                                          Oregon Department of Revenue
138                       2022 Form OR-40                                                                                                                                     138
139                                                                                                                                                                           139
140                                                                                                                                                                           140
141                       Page 3 of 8   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           141
142          Last name                                                                                                             SSN                                        142
143                                                                                                                                                                           143
144                                                                                                                                                                           144
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                      999-99-9999
145                                                                                                                                                                           145
146          Note: Reprint page 1 if you make changes to this page.                                                                                                           146
147          Taxable income                                                                                                                                                   147
148            7.  Federal adjusted gross income from federal Form 1040, 1040-SR, or                                                                                          148
149                 1040-NR, line 11; or 1040-X, line 1C (see instructions) .............................................. 7.             ,   999,999,999.00,             0 0 149
150                                                                                                                                                                           150
151                                                                                                                                                                           151
152            8.  Total additions from Schedule OR-ASC, line A5 ........................................................ 8.              ,   999,999,999.00,             0 0 152
153                                                                                                                                                                           153
154                                                                                                                                                                           154
155            9.  Income after additions. Add lines 7 and 8 .................................................................. 9.        ,   999,999,999.00,             0 0 155
156                                                                                                                                                                           156
157          Subtractions                                                                                                                                                     157
158                                                                                                                                                                           158
159            10.  2022 federal tax liability (see instructions) ............................................................. 10.       ,   999,999,999.00,             0 0 159
160                                                                                                                                                                           160
161                                                                                                                                                                           161
162            11.  Social Security amount on federal Form 1040 or 1040-SR, line 6b ......................... 11.                         ,   999,999,999.00,             0 0 162
163                                                                                                                                                                           163
164                                                                                                                                                                           164
165            12.  Oregon income tax refund included in federal income ............................................. 12.                 ,   999,999,999.00,             0 0 165
166                                                                                                                                                                           166
167                                                                                                                                                                           167
168            13.  Total subtractions from Schedule OR-ASC, line B7 ................................................. 13.                ,   999,999,999.00,             0 0 168
169                                                                                                                                                                           169
170                                                                                                                                                                           170
171            14.  Total subtractions. Add lines 10 through 13 ............................................................. 14.         ,   999,999,999.00,             0 0 171
172                                                                                                                                                                           172
173                                                                                                                                                                           173
174            15.  Income after subtractions. Line 9 minus line 14 ....................................................... 15.           ,   999,999,999.00,             0 0 174
175                                                                                                                                                                           175
176          Deductions                                                                                                                                                       176
177            16.  Oregon itemized deductions. Enter your Oregon itemized deductions from                                                                                    177
178                 Schedule OR-A, line 23. If you are not itemizing your deductions, enter 0 .............. 16.                          ,   999,999,999.00,             0 0 178
179                                                                                                                                                                           179
180                                                                                                                                                                           180
181            17.  Standard deduction. Enter your standard deduction ............................................. 17.                   ,   999,999,999.00,             0 0 181
182                                                                                                                                                                           182
183                 You were:           17a.   X     65 or older           17b. X Blind  Your spouse was:                          17c. X 65 or older  17d. X       Blind     183
184                                                                                                                                                                           184
185                 Standard deductions                                                                                                                                       185
186                          Single                 Married filing jointly      Married filing separately Qualifying surviving spouse         Head of Household               186
187                          $2,420                    $4,840                     $2,420 or $0                                     $4,840     $3,895                          187
188                 See instructions if you are age 65 or older, blind, or if someone can claim you as a dependent.                                                           188
189                 See instructions if you are married filing separately.                                                                                                    189
190                                                                                                                                                                           190
191                                                                                                                                                                           191
192                                                                                                                                                                           192
193                                                                                                                                                                           193
194                                                                                                                                                                           194
195                                                                                                                                                                           195
                          150-101-040
196                       (Rev. 09-12-22, ver. 01)                                                                                        00462201030000                      196
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198                                                                                                                                                                           198

199                                                                                                                                                                                     199
  1  2   200   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   200   84 85
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201                                                                                                                                                                                     201
202                                                                                                                                                                                     202
203                                                                                                                                                                                     203
                                                                                                                                                        Oregon Department of Revenue
204                        2022 Form OR-40                                                                                                                                              204
205                                                                                                                                                                                     205
206                                                                                                                                                                                     206
207                        Page 4 of 8   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.                    207
208          Last name                                                                                                                              SSN                                 208
209                                                                                                                                                                                     209
210                                                                                                                                                                                     210
211          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                       999-99-9999                         211
212          Note: Reprint page 1 if you make changes to this page.                                                                                                                     212
213           Deductions (continued)                                                                                                                                                    213
214                                                                                                                                                                                     214
215            18.   Enter the larger of line 16 or 17 ................................................................................. 18.            ,         999,999,999.00,   0 0 215
216                                                                                                                                                                                     216
217                                                                                                                                                                                     217
               19.  Oregon taxable income. Line 15 minus line 18. If line 18 is more than  
218                 line 15, enter 0 .......................................................................................................... 19.     ,         999,999,999.00,   0 0 218
219                                                                                                                                                                                     219
220                                                                                                                                                                                     220
             Oregon tax
221                                                                                                                                                                                     221
222            20.  Tax (see instructions) ................................................................................................ 20.         ,         999,999,999.00,   0 0 222
223                                                                                                                                                                                     223
                 Check the appropriate box if you’re using an alternative method to calculate your tax:
224                                                                                                                                                                                     224
225                                                                                                                                                                                     225
                 20a.      X    Schedule OR-FIA-40         20b.   X   Worksheet FCG        20c. X                                               Schedule OR-PTE-FY
226                                                                                                                                                                                     226
227                                                                                                                                                                                     227
228            21.  Interest on certain installment sales ......................................................................... 21.                 ,         999,999,999.00,   0 0 228
229                                                                                                                                                                                     229
230                                                                                                                                                                                     230
231            22.  Total tax before credits. Add lines 20 and 21 ........................................................... 22.                       ,         999,999,999.00,   0 0 231
232                                                                                                                                                                                     232
233                                                                                                                                                                                     233
             Standard and carryforward credits
234                                                                                                                                                                                     234
               23.  Exemption credit. If the amount on line 7 is $100,000 or less, multiply your total 
235                 exemptions on line 6e by $219. Otherwise, see instructions ................................... 23.                                  ,         999,999,999.00,   0 0 235
236                                                                                                                                                                                     236
237                                                                                                                                                                                     237
238            24.  Political contribution credit.  See limits in instructions ........................................... 24.                          ,         999,999,999.00,   0 0 238
239                                                                                                                                                                                     239
240                                                                                                                                                                                     240
241            25.  Total standard credits from Schedule OR-ASC, line C16 ........................................ 25.                                  ,         999,999,999.00,   0 0 241
242                                                                                                                                                                                     242
243                                                                                                                                                                                     243
244            26.  Total standard credits. Add lines 23 through 25 ....................................................... 26.                         ,         999,999,999.00,   0 0 244
245                                                                                                                                                                                     245
246                                                                                                                                                                                     246
               27.  Tax minus standard credits. Line 22 minus line 26. If line 26 is more than  
247                 line 22, enter 0 .......................................................................................................... 27.     ,         999,999,999.00,   0 0 247
248                                                                                                                                                                                     248
249                                                                                                                                                                                     249
               28.  Total carryforward credits used this year from Schedule OR-ASC, line D9.  
250                 Line 28 can’t be more than line 27 (see Schedule OR-ASC instructions) ................ 28.                                          ,         999,999,999.00,   0 0 250
251                                                                                                                                                                                     251
252                                                                                                                                                                                     252
253            29.  Tax after standard and carryforward credits. Line 27 minus line 28 ......................... 29.                                    ,         999,999,999.00,   0 0 253
254                                                                                                                                                                                     254
255                                                                                                                                                                                     255
256            30.   Total tax recaptures reported this year from Schedule OR-ASC, line E5 ................. 30.                                        ,         999,999,999.00,   0 0 256
257                                                                                                                                                                                     257
258                                                                                                                                                                                     258
259                                                                                                                                                                                     259
260                                                                                                                                                                                     260
261                                                                                                                                                                                     261
                           150-101-040
262                        (Rev. 09-12-22, ver. 01)                                                                                                     00462201040000                  262
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264                                                                                                                                                                                     264

265                                                                                                                                                                                     265
  1  2   266   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   266   84 85
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267                                                                                                                                                                                     267
268                                                                                                                                                                                     268
                                                                                                                                                        Oregon Department of Revenue
269                         2022 Form OR-40                                                                                                                                             269
270                         Oregon Individual Income Tax Return for Full-year Residents                                                                                                 270
271                                                                                                                                                                                     271
272                         Page 5 of 8    • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.                  272
273          Last name                                                                                                                         SSN                                      273
274                                                                                                                                                                                     274
275                                                                                                                                                                                     275
276          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                  999-99-9999                              276
277          Note: Reprint page 1 if you make changes to this page.                                                                                                                     277
278          Standard and carryforward credits (continued)                                                                                                                              278
279                                                                                                                                                                                     279
280          31.   Tax including tax recaptures. Line 29 plus line 30 ....................................................... 31.                       ,  999,999,999.00,          0 0 280
281                                                                                                                                                                                     281
282          Payments and refundable credits                                                                                                                                            282
283                                                                                                                                                                                     283
284            32.  Oregon income tax withheld.      Include a copy of your Forms W-2 and 1099 ........  32.                                            ,  999,999,999.00,          0 0 284
285                                                                                                                                                                                     285
286                                                                                                                                                                                     286
287            33.  Amount applied from your prior year’s tax refund .................................................... 33.                           ,  999,999,999.00,          0 0 287
288                                                                                                                                                                                     288
289            34.  Estimated tax payments for 2022. Include all payments you made before                                                                                               289
290                 filing this return (see instructions). Do not include the amount on line 33 ................ 34.                                    ,  999,999,999.00,          0 0 290
291                                                                                                                                                                                     291
292                                                                                                                                                                                     292
293            35.  Tax payments from a pass-through entity ................................................................ 35.                        ,  999,999,999.00,          0 0 293
294                                                                                                                                                                                     294
295                                                                                                                                                                                     295
296            36.  Earned income credit (see instructions) .................................................................... 36.                    ,  999,999,999.00,          0 0 296
297                                                                                                                                                                                     297
298            Reserved37.  Kicker (Oregon surplus credit). Enter your kicker credit amount                                                                                             298
299                 (see instructions). If you elect to donate your kicker to the                                                                                                       299
300                 State School Fund, enter 0 and see line 53 .......................................................... 37.                                                           300
301                                                                                                                                                                                     301
302                                                                                                                                                                                     302
303            38.  Total refundable credits from Schedule OR-ASC, line F7 ........................................ 38.                                 ,  999,999,999.00,          0 0 303
304                                                                                                                                                                                     304
305                                                                                                                                                                                     305
306            39.  Total payments and refundable credits. Add lines 32 through 38 ............................ 39.                                     ,  999,999,999.00,          0 0 306
307                                                                                                                                                                                     307
308          Tax to pay or refund                                                                                                                                                       308
309            40.  Overpayment of tax. If line 31 is less than line 39, you overpaid.                                                                                                  309
310                 Line 39 minus line 31 ................................................................................................ 40.          ,  999,999,999.00,          0 0 310
311                                                                                                                                                                                     311
312            41.  Net tax. If line 31 is more than line 39, you have tax to pay.                                                                                                      312
313                 Line 31 minus line 39 ................................................................................................ 41.          ,  999,999,999.00,          0 0 313
314                                                                                                                                                                                     314
315                                                                                                                                                                                     315
316            42.  Penalty and interest for filing or paying late (see instructions) ................................. 42.                             ,  999,999,999.00,          0 0 316
317                                                                                                                                                                                     317
318                                                                                                                                                                                     318
319            43.  Interest on underpayment of estimated tax.          Include Form OR-10 ......................... 43.                                ,  999,999,999.00,          0 0 319
320                                                                                                                                                                                     320
321                                                                                                                                                                                     321
322              Exception number from Form OR-10, line 1               43a.         9 Check box if you annualized:                                43b. X                               322
323                                                                                                                                                                                     323
324                                                                                                                                                                                     324
325                                                                                                                                                                                     325
326                                                                                                                                                                                     326
                            150-101-040
327                         (Rev. 09-12-22, ver. 01)                                                                                                    00462201050000                  327
328                                                                                                                                                                                     328
  1  2   329   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   329   84 85
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330                                                                                                                                                                                     330

331                                                                                                                                                                                   331
  1  2   332   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   332   84 85
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333                                                                                                                                                                                   333
334                                                                                                                                                                                   334
                                                                                                                                                      Oregon Department of Revenue
335                        2022 Form OR-40                                                                                                                                            335
336                                                                                                                                                                                   336
337                                                                                                                                                                                   337
338                        Page 6 of 8   • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.                  338
339          Last name                                                                                                                            SSN                                 339
340                                                                                                                                                                                   340
341                                                                                                                                                                                   341
342          XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                     999-99-9999                         342
343          Note: Reprint page 1 if you make changes to this page.                                                                                                                   343
344           Tax to pay or refund (continued)                                                                                                                                        344
345                                                                                                                                                                                   345
346            44.  Total penalty and interest due. Add lines 42 and 43 ................................................ 44.                          ,       999,999,999.00,     0 0 346
347                                                                                                                                                                                   347
348           45.   Net tax including penalty and interest.                                                                                                                           348
349                 Line 41 plus line 44 ..................................................This is the amount you owe. 45.                            ,       999,999,999.00,     0 0 349
350                                                                                                                                                                                   350
351            46.  Overpayment less penalty and interest.                                                                                                                            351
352                 Line 40 minus line 44 ...............................................................This is your refund. 46.                     ,       999,999,999.00,     0 0 352
353                                                                                                                                                                                   353
354            47.  Estimated tax. Fill in the portion of line 46 you want applied to your open                                                                                       354
355                 estimated tax account .............................................................................................. 47.          ,       999,999,999.00,     0 0 355
356                                                                                                                                                                                   356
357                                                                                                                                                                                   357
358            48.  Charitable checkoff donations from Schedule OR-DONATE, line 30 ....................... 48.                                        ,       999,999,999.00,     0 0 358
359                                                                                                                                                                                   359
360                                                                                                                                                                                   360
361            49.  Political party $3 checkoff ........................................................................................ 49.          ,       999,999,999.00,     0 0 361
362                                                                                                                                                                                   362
363                                                                                                                                                                                   363
364                 Party code:          49a.  You             999                          49b.  Spouse              999                                                             364
365                                                                                                                                                                                   365
366            50.  Oregon 529 college savings plan deposits from Schedule OR-529, line 5 .............. 50.                                          ,       999,999,999.00,     0 0 366
367                                                                                                                                                                                   367
368            51.  Total. Add lines 47 through 50. Line 51 can’t be more than your                                                                                                   368
369                 refund on line 46 ....................................................................................................... 51.     ,       999,999,999.00,     0 0 369
370                                                                                                                                                                                   370
371                                                                                                                                                                                   371
372            52.  Net refund.Line 46 minus line 51 ....................................This is your net refund. 52.                                 ,       999,999,999.00,     0 0 372
373                                                                                                                                                                                   373
374          Direct deposit                                                                                                                                                           374
375            53.  For direct deposit of your refund, see instructions. Check the box if the final deposit destination is outside the United States:                X                375
376                                                                                                                                                                                   376
377                 Type of account:                                                                                                                                                  377
378                                                    Account information:                                                                                                           378
379                 X      Checking or                 Routing number                                                 Account number                                                  379
380                                                                                                                                                                                   380
381                 X      Savings                                                          999999999                 XXXXXXXXXXXXXXXXX                                               381
382                                                                                                                                                                                   382
383                                                                                                                                                                                   383
384          KickerReserveddonation                                                                                                                                                   384
385            54.  If you elect to donate your kicker to the State School Fund, check this box. .........  54a.                                                                      385
386                                                                                                                                                                                   386
387              Complete the kicker worksheet, located in the instructions, and enter the                                                                                            387
388                 amount here. ...........................................................This election is irrevocable.  54b.                                                       388
389                                                                                                                                                                                   389
390                                                                                                                                                                                   390
391                                                                                                                                                                                   391
392                                                                                                                                                                                   392
                           150-101-040
393                        (Rev. 09-12-22, ver. 01)                                                                                                   00462201060000                  393
394                                                                                                                                                                                   394
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396                                                                                                                                                                                   396

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  1  2   398   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   398   84 85
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399                                                                                                                                                                       399
400                                                                                                                                                                       400
                                                                                                                 Oregon Department of Revenue
401                     2022 Form OR-40                                                                                                                                   401
402                                                                                                                                                                       402
403                                                                                                                                                                       403
404                     Page 7 of 8 • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.           404
405          Last name                                                                                SSN                                                                 405
406                                                                                                                                                                       406
407                                                                                                                                                                       407
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                         999-99-9999
408                                                                                                                                                                       408
409          Note: Reprint page 1 if you make changes to this page.                                                                                                       409
410          Sign here.  Under penalty of false swearing, I declare that the information in this return and any attachments is true, correct and complete.                410
411                                                                                                                                                                       411
412            Your signature                                                                                                                                             412
413                                                                                                                                                                       413
414          X                                                                                                                                                            414
415          Date (MM/DD/YYYY)                                                                                                                                            415
416                                                                                                                                                                       416
417          99/99/9999/         /                                                                                                                                        417
418            Spouse signature                                                                                                                                           418
419                                                                                                                                                                       419
420          X                                                                                                                                                            420
421          Date (MM/DD/YYYY)                                                                                                                                            421
422                                                                                                                                                                       422
423          99/99/9999/         /                                                                                                                                        423
424            Signature of preparer other than taxpayer                                                                                                                  424
425                                                                                                                                                                       425
426          X                                                                                                                                                            426
427          Date (MM/DD/YYYY)                           Preparer phone                                          Preparer license number                                  427
428                                                                                                                                                                       428
429          99/99/9999/         /                       999-999-9999                                            XXXXXXXXXX                                               429
430          Preparer first name                            Initial     Preparer last name                                                                                430
431                                                                                                                                                                       431
432                                                                                                                                                                       432
             XXXXXXXXXXXXXXXX                               X           XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
433          Preparer address                                                                                                                                             433
434                                                                                                                                                                       434
435                                                                                                                                                                       435
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
436          City                                                                                          State ZIP code                                                 436
437                                                                                                                                                                       437
438                                                                                                                                                                       438
             XXXXXXXXXXXXXXXXXXXXXX                                                                        XX    XXXXX-XXXX
439          Signing this return does not grant your preparer the right to represent you or make decisions on your behalf. For more information, see the instructions for 439
440          the Tax Information Authorization and Power of Attorney for Representation form on our website.                                                              440
441                                                                                                                                                                       441
442          Important: Include a copy of your federal Form 1040, 1040-SR, 1040-X, or 1040-NR. We may adjust your return without it.                                      442
443                                                                                                                                                                       443
444          Pay the amount due (shown on line 45)                                                                                                                        444
445          • Online: www.oregon.gov/dor.                                                                                                                                445
446          • By mail: Payable to the Oregon Department of Revenue.Write “2022 Oregon Form OR-40” and the last four digits of your SSN or ITIN on your                   446
447            check or money order. If you include a payment with your return, don’t include Form OR-40-V payment voucher.                                               447
448                                                                                                                                                                       448
449          Mail your return                                                                                                                                             449
450          • Non-2-D barcode. If the large 2-D barcode box on the first page of this form is blank:                                                                     450
451            —  Mail tax-due returns to: Oregon Department of Revenue, PO Box 14555, Salem OR 97309-0940.                                                               451
452            —  Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14700, Salem OR 97309-0930.                                                 452
453          • 2-D barcode. If the large 2-D barcode box on the first page of this form is filled in:                                                                     453
454            —  Mail tax-due returns to: Oregon Department of Revenue, PO Box 14720, Salem OR 97309-0463.                                                               454
455            —  Mail refund and no-tax-due returns to: Oregon Department of Revenue, PO Box 14710, Salem OR 97309-0460.                                                 455
456                                                                                                                                                                       456
457                                                                                                                                                                       457
458                                                                                                                                                                       458
                        150-101-040
459                     (Rev. 09-12-22, ver. 01)                                                                 00462201070000                                           459
460                                                                                                                                                                       460
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462                                                                                                                                                                       462

463                                                                                                                                                               463
  1  2   464   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   464   84 85
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465                                                                                                                                                               465
466                                                                                                                                                               466
                                                                                    Oregon Department of Revenue
467                    2022 Form OR-40                                                                                                                            467
468                                                                                                                                                               468
469                                                                                                                                                               469
470                    Page 8 of 8 • Use UPPERCASE letters.  • Use blue or black ink.  • Print actual size (100%).  • Don’t submit photocopies or use staples.    470
471          Last name                                                          SSN                                                                               471
472                                                                                                                                                               472
473                                                                                                                                                               473
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                   999-99-9999
474                                                                                                                                                               474
475          Note: Reprint page 1 if you make changes to this page.                                                                                               475
476          Amended statement. Complete this section only if you’re amending your 2022 return or filing with a new SSN.                                          476
477                                                                                                                                                               477
478          If filing an amended return, use this space to explain what you’re changing. Include the return line numbers and the reason for each change. If your 478
479          filing status has changed, explain why. Include all supporting forms and schedules when you file your amended return, even if you haven’t changed    479
480          anything on them.                                                                                                                                    480
481                                                                                                                                                               481
482          If filing with a new SSN, enter your former identification number.                                                                                   482
483                                                                                                                                                               483
484                                                                                                                                                               484
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
485                                                                                                                                                               485
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486                                                                                                                                                               486
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487                                                                                                                                                               487
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488                                                                                                                                                               488
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489                                                                                                                                                               489
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
490                                                                                                                                                               490
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
491                                                                                                                                                               491
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
492                                                                                                                                                               492
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
493                                                                                                                                                               493
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
494                                                                                                                                                               494
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
495                                                                                                                                                               495
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
496                                                                                                                                                               496
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497                                                                                                                                                               497
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
498                                                                                                                                                               498
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499                                                                                                                                                               499
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
500                                                                                                                                                               500
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
501                                                                                                                                                               501
             XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
502                                                                                                                                                               502
503                                                                                                                                                               503
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518                                                                                                                                                               518
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522                                                                                                                                                               522
523                                                                                                                                                               523
524                                                                                                                                                               524
                       150-101-040
525                    (Rev. 09-12-22, ver. 01)                                     00462201080000                                                                525
526                                                                                                                                                               526
  1  2   527   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   527   84 85
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528                                                                                                                                                               528