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FORM
             OREGON AGRICULTURAL ANNUAL WITHHOLDING TAX RETURN                                                                          Year
                                      For 1996 and Subsequent Tax Years
WA
Agricultural employers who qualify to file annually may use this form. Use your federal Form 943 and your 
Oregon withholding tax records to complete this information. REMEMBER — the due dates for paying                                      Revenue Use Only
your Oregon withholding taxes are the same as the due dates for making your federal deposits.                            Date Received
 THIS RETURN IS DUE BY

                                                                                              NO PAYROLL: If you had no payroll write -0- in Box 1 
                                                                                              and Box 2. Sign Form WA and file by the due date.
 Business name and address
                                                                                                                                        Business ID Number

BOX 1     Fill in Oregon gross payroll for the calendar year. Include total                                           Fill in Oregon  
          wages, salaries, commissions, bonuses, fees, etc.                                     1                     gross payroll paid
BOX 2     Enter total Oregon tax withheld from employees pay this year                                                Total Oregon 
          (from Sections A and B).                                                              2                     tax withheld
                                                                                                                      Total Oregon 
BOX 3     Enter total Oregon tax paid this year.                                                3                     tax paid

BOX 4     AMOUNT DUE—If Box 3 is less than Box 2, enter difference in Box 4.                                          AMOUNT DUE
          Include payment and payment coupon (Form OTC) with this return.                       4

BOX 5     CREDIT—If Box 3 is more than Box 2, enter difference in Box 5.                        5                     CREDIT

Section A: Complete if you are a monthly depositor. Enter Oregon tax liability in column next to the month liability was incurred.
Deposit Period Ending              Tax Liability for Month Deposit Period Ending              Tax Liability for Month Deposit Period Ending                                           Tax Liability for Month
A  January 31 ..................                           F  June 30 .......................                         K November 30 ..............
B February 28 ................                             G July 31  .......................                         L  December 31 ..............
C March 31 ....................                            H August 31 ...................                            Total for year .................
D April 30 .......................                         I  September 30 .............                              (Enter here and in Box 2 above)
E  May 31 ........................                         J  October 31 .................

Section B: You must complete this section if you are required to deposit on a semiweekly basis, or if your federal tax liability 
on any day is $100,000 or more. Enter Oregon tax liability here, not deposits.
    A. Daily Tax Liability — January                          B. Daily Tax Liability — February                          C. Daily Tax Liability — March
 1                                 16                      1                              16                          1                               16
 2                                 17                      2                              17                          2                               17
 3                                 18                      3                              18                          3                               18
 4                                 19                      4                              19                          4                               19
 5                                 20                      5                              20                          5                               20
 6                                 21                      6                              21                          6                               21
 7                                 22                      7                              22                          7                               22
 8                                 23                      8                              23                          8                               23
 9                                 24                      9                              24                          9                               24
10                                 25                      10                             25                          10                              25
11                                 26                      11                             26                          11                              26
12                                 27                      12                             27                          12                              27
13                                 28                      13                             28                          13                              28
14                                 29                      14                             29                          14                              29
15                                 30                      15                                                         15                              30
                                   31                                                                                                                 31
 Total Liability for Month A   ➛                            Total Liability for Month B   ➛                            Total Liability for Month C   ➛
1. Total for Quarter (Add lines A, B, and C) ........................................................................................................................................ ➛
150-206-013-1 (Rev. 04-20-20)                                                                                         Second, third, and fourth quarter information on page 2

     D. Daily Tax Liability — April               E. Daily Tax Liability — May                    F. Daily Tax Liability — June
 1                             16              1                                      16       1                             16
 2                             17              2                                      17       2                             17
 3                             18              3                                      18       3                             18
 4                             19              4                                      19       4                             19
 5                             20              5                                      20       5                             20
 6                             21              6                                      21       6                             21
 7                             22              7                                      22       7                             22
 8                             23              8                                      23       8                             23
 9                             24              9                                      24       9                             24
10                             25              10                                     25       10                            25
11                             26              11                                     26       11                            26
12                             27              12                                     27       12                            27
13                             28              13                                     28       13                            28
14                             29              14                                     29       14                            29
15                             30              15                                     30       15                            30
                               31                                                     31                                     31
 Total Liability for Month D  ➛                 Total Liability for Month E  ➛                  Total Liability for Month F  ➛
2. Total for Quarter (Add lines D, E, and F) ..................................................................................................................................... ➛
     G. Daily Tax Liability — July                H. Daily Tax Liability — August                 I. Daily Tax Liability — September
 1                             16              1                                      16       1                             16
 2                             17              2                                      17       2                             17
 3                             18              3                                      18       3                             18
 4                             19              4                                      19       4                             19
 5                             20              5                                      20       5                             20
 6                             21              6                                      21       6                             21
 7                             22              7                                      22       7                             22
 8                             23              8                                      23       8                             23
 9                             24              9                                      24       9                             24
10                             25              10                                     25       10                            25
11                             26              11                                     26       11                            26
12                             27              12                                     27       12                            27
13                             28              13                                     28       13                            28
14                             29              14                                     29       14                            29
15                             30              15                                     30       15                            30
                               31                                                     31                                     31
 Total Liability for Month G  ➛                 Total Liability for Month H  ➛                  Total Liability for Month I  ➛
3. Total for Quarter (Add lines G, H, and I) ..................................................................................................................................... ➛
     J. Daily Tax Liability — October             K. Daily Tax Liability — November               L. Daily Tax Liability — December
 1                             16              1                                      16       1                             16
 2                             17              2                                      17       2                             17
 3                             18              3                                      18       3                             18
 4                             19              4                                      19       4                             19
 5                             20              5                                      20       5                             20
 6                             21              6                                      21       6                             21
 7                             22              7                                      22       7                             22
 8                             23              8                                      23       8                             23
 9                             24              9                                      24       9                             24
10                             25              10                                     25       10                            25
11                             26              11                                     26       11                            26
12                             27              12                                     27       12                            27
13                             28              13                                     28       13                            28
14                             29              14                                     29       14                            29
15                             30              15                                     30       15                            30
                               31                                                     31                                     31
 Total Liability for Month J  ➛                 Total Liability for Month K ➛                   Total Liability for Month L  ➛
4. Total for Quarter (Add lines J, K, and L) ......................................................................................................................................  ➛
5. TOTAL FOR YEAR (Add lines 1, 2, 3 and 4) (enter here and in Box 2 on the front) .....................................................................  ➛
In addition to Form WA, file Form WR, Oregon Withholding Tax Annual Reconciliation Report.  
For more information, call us at 503-945-8091.                                                    Mail to:
     This report is true, correct, and is filed under penalty of false swearing. Date    Phone    Oregon Department of Revenue
SIGN                                                                                              PO Box 14800
                                                                                                  Salem OR 97309-0920
150-206-013-1 (Rev. 04-20-20)