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                                Schedule OR-21-MD Instructions                                              2022
                               Oregon Pass-through Entity Elective Tax Member Directory

                                                                 name, SSN, and address in the same manner as an indi-
Purpose of Schedule OR-21-MD                                     vidual. Otherwise, indicate which type of organization the 
                                                                 LLC is treated as for tax purposes.
Pass-through entities (PTEs) electing to pay the PTE elective 
tax (PTE-E tax) use Schedule OR-21-MD to provide informa-        Identification number. Enter the member’s SSN if the mem-
tion about the members of the PTE. Schedule OR-21-MD             ber is an individual, or the member’s FEIN if the member 
must be included with Form OR-21 when the return is filed.       is a PTE.
The election to be liable for and pay the PTE-E tax can be       Current address and phone. Enter the member’s current 
made only by entities whose members are:                         address, including city, state, and ZIP code. Include a day-
                                                                 time phone where the member or the member’s contact can 
• Individuals who are subject to Oregon’s personal income 
                                                                 be reached.
tax laws, or
                                                                 Column r: Distributive proceeds. Each member’s share of 
• Entities that are PTEs owned entirely by such individuals.
                                                                 distributive proceeds is based on information reported on 
By providing the information required by Schedule OR-            the entity’s Form OR-65 or Form OR-20-S. (For members who 
21-MD, the electing PTE confirms that it qualifies to make       are individuals, this information is reported to members 
the election.                                                    on Schedule OR-K-1, Part III, lines 1 through 11, Oregon 
Complete Form OR-21 before completing this schedule.             column.)
                                                                 Column s:  Addition for tax deducted at federal level. Taxes 
                                                                 paid by the electing PTE to the State of Oregon that are 
Part A: Member information                                       deducted on a federal return filed by the entity must be 
Complete all fields for each member. If the electing PTE         added to Oregon income. Individual members of the electing 
has more than two members, use additional copies of the          PTE, or individual members of a PTE that is a member of 
schedule to list all members.                                    the electing PTE, report their share of the addition on their 
                                                                 Oregon personal income tax returns, including composite 
PTE member legal name and contact name. If the member is         returns joined by nonresident individuals. 
a PTE, the legal name must be entered even if the PTE does 
business under an assumed name. Enter the first name, mid-       The total addition amount can be found as a deduction for 
dle initial, and last name of a contact person for the member    state taxes paid on the applicable federal return, such as 
PTE. If the member is an individual, skip these fields.          Form 1065 or Form 1120-S. For each member with a posi-
                                                                 tive share of distributive proceeds in column r, divide the 
Ownership percentage. Enter each member’s ownership              member’s share by the total distributive proceeds from Form 
percentage as of the close of the tax year. If the member        OR-21, line 22. Multiply this percentage by the total addition 
disposed of all or part of an ownership interest during the      amount. Enter the result in column s. 
year, enter the member’s ownership percentage before the 
disposition.                                                     Column t: Credit for PTE-E tax paid. Multiply the total 
                                                                 amount of the PTE-E tax shown on Form OR-21, line 23, 
Form OR-OC. Mark this box if the member is a nonresident         by the percentage for each member determined using the 
individual who elects to be included in a composite filing       process described in the instructions for column s. Enter 
for this tax year.                                               the result in column t. Do not include penalty, interest on 
Individual member name. If the member is an individual,          unpaid tax, or interest on an underpayment of estimated tax.
enter their first name, middle initial, and last name. If the 
member is a PTE, skip these fields.
                                                                 Part B: Total distributive proceeds, 
Member type. Indicate whether the member is a partnership,                             Sole proprietorship
                                                                 addition, and credit
S corporation, or an individual.
• Grantor trust. If the member is a grantor trust (also known    Line 3: Total distributive proceeds. Add together all of the 
as a revocable trust or living trust), select “Individual” and   shares of distributive proceeds from Oregon sources for each 
enter the grantor’s name, Social Security number (SSN),          member in column r.
and address in the same manner as an individual. Don’t 
                                                                 Line 4: Total addition for tax deducted at federal level. Total 
enter the name, federal employer identification number 
                                                                 all of the shares of the Oregon addition for each member in 
(FEIN), or address of the grantor trust.
                                                                 column s. The total should equal the amount of taxes paid to 
• Limited liability company (LLC). If the member is a single-    the State of Oregon that were deducted on a federal return 
member LLC, select “Individual” and enter the member’s           filed by the entity.

150-107-112-1 (Rev. 09-13-22)                                  1                       2022 Schedule OR-21-MD Instructions



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Line 5: Total credit for PTE-E tax paid. Add together all of 
the shares of PTE-E tax credit for each member in column       Do you have questions or need help?
t. The total should equal the amount of PTE-E tax on Form 
                                                                 www.oregon.gov/dor
OR-21, line 23.
                                                               503-378-4988 or 800-356-4222
Caution: If any of the total amounts do not match the          questions.dor@dor.oregon.gov
amounts from Form OR-21 or the applicable federal return, 
                                                               Contact us for ADA accommodations or assistance in other 
the schedule is not complete. Make any necessary correc-
                                                               languages.
tions before filing Form OR-21.
Include the completed schedule, including any additional 
pages, when filing Form OR-21.

150-107-112-1 (Rev. 09-13-22)                                2                     2022 Schedule OR-21-MD Instructions






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