Form OR-40-V, Oregon Individual Income Tax Payment Voucher ...
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Form OR-40-V
Oregon Individual Income Tax Payment Voucher
Oregon Department of Revenue
Page 1 of 1 ? Use UPPERCASE letters. ? Use blue or black ink. ? Print actual size (100%). ? Don't submit photocopies or use staples.
Tax year begins (MM/DD/YYYY)
/
/
Tax year ends (MM/DD/YYYY)
/
/
For taxpayer use only: Enter quarter (if making an estimated payment)
First name
Initial
Last name
Social Security number (SSN)
Spouse first name Spouse last name Spouse SSN
Initial
Current mailing address City Contact phone
State
ZIP code
Want to make your payment online? Find options at dor. Use this voucher only if you are sending a payment separate from a return. For more information, see Form OR-40-V Instructions. Make your check, money order, or cashier's check payable to the Oregon Department of Revenue. Write "Form OR-40-V," your daytime phone, the last four digits of your SSN or ITIN, and the tax year on your payment. Don't mail cash. Mail the payment and voucher to:
Oregon Department of Revenue PO Box 14950 Salem OR 97309-0950
150-101-172 (Rev. 08-16-22, ver. 04)
Payment type (check one) Original return Estimated payment Amended return
Enter payment amount
$
,
,
0 0
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