Oregon Schedule B Amended
                            State Withholding Tax
              Business identification number (BIN) Quarter/Year (Q/YY)
                                                                                         6528010123
Business name                                      /
                                                                                                                                                                             Date received

A.  Daily Oregon withholding tax — First month of Quarter 

  1.                        8.                           15.          22.                          29.

  2.                        9.                           16.          23.                          30.

3.                          10.                          17.          24.                          31.

4.                          11.                          18.          25.

5.                          12.                          19.          26.

6.                          13.                          20.          27.

7.                          14.                          21.          28.
  A.  Total tax liability for the first month of the quarter .............................................................................................................A. 
B.  Daily Oregon withholding tax — Second month of Quarter 

  1.                        8.                           15.          22.                          29.

  2.                        9.                           16.          23.                          30.

3.                          10.                          17.          24.                          31.

4.                          11.                          18.          25.

5.                          12.                          19.          26.

6.                          13.                          20.          27.

7.                          14.                          21.          28.
  B.  Total tax liability for the second month of the quarter .......................................................................................................B. 
C.  Daily Oregon withholding tax — Third month of Quarter 

  1.                        8.                           15.          22.                          29.

  2.                        9.                           16.          23.                          30.

3.                          10.                          17.          24.                          31.

4.                          11.                          18.          25.

5.                          12.                          19.          26.

6.                          13.                          20.          27.

7.                          14.                          21.          28.
  C.  Total tax liability for the third month of the quarter ........................................................................................................... C. 

D.  Total for the quarter (Add boxes A, B, and C). Enter this amount in box 2A on Form OQ .............................................D. 

150-206-528 (Rev. 08-18-22)                                                                                                                                                  Page 1 of 1