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85321
Oregon Fiduciary Tax Payment Voucher Department of Revenue Use Only150-101-173 (Rev. 10-12) DRAFT 2, 07-26-12
$Enter Payment Amount
. 0 0
•
Tax return type (check only one):
(102)
(101)•
Trust (102)
(102) Bankruptcy estate
Funeral trust
FORM
41-VExtension
Payment type (check only one):Original return
•
Amended return
First-time filer New name or address
Prepayment
Oregon Fiduciary Tax Payment Voucher Instructions
Use this voucher to send the following payments:•Taxduewhenyoufileyouroriginal return or an amended returnforanyyear.•Taxduebytheoriginalreturn’sduedateifyouarefilingyourreturnonextension.•Taxpre-payments.(Oregondoesn’trequirepre-paymentsforfiduciaryreturns.)Taxpaymentisduebytheoriginalduedateofyourreturn.
Do not use this voucher for payments on:•Oregoninheritancetaxreturn.Instead,useFormIT-V,150-101-172.•Oregonindividualtaxreturn.Instead,useForm40-V,150-101-173.•Oregonestatetransfertaxreturn.Instead,useFormOR706-V,150-104-172.
Required for accurate processing:•Tax year:Fillinyourcalendaryearoryourfiscalyearorshort-yearperiod.ThiscalendaryearorfiscalyearmustmatchForm41andfederalForm1041.
•Payment type:Checktheboxthatidentifiesthetypeofpaymentyou’resending.•BIN: FillintheOregonBIN(businessidentificationnumber).Ifyoudon’tknowyourBINorifthisisyourfirstfilingwithus,leaveblankandwe’llassignaBIN(OregonBINisnotyourOregonregistrynumber).
•FEIN: FillinyourFEIN(federalemployeridentificationnumberassignedbytheInternalRevenueService).•Name, address, and telephone number:FillintheexactnameoftheestateortrustasitwillbeshownonForm41whenfiled.Fillinthenameofthepersonalrepresentativeortrusteeinthespacelabeledfiduciary,andthefiduciary’saddressandtelephonenumber.
•First time filer/name or address change:Checkthefirsttimefilerboxifthisisyourfirstreturnfiled.Ifthenameoraddressofthetrustorestatehaschanged,checkthenameoraddresschangebox.
•Make your check payable to:OregonDepartmentofRevenue.•To make surewematchthispaymenttoyourreturn,write thetrustorestatename,BINorFEIN,taxyear,andadaytimetelephonenumberon your check or money order.
•Mail the voucherwithyourpaymentto:Oregon Department of Revenue
PO Box 14110Salem OR 97309-0910
Note:Thisvouchermaybeusedasanextensiononlyifyouaremakingapayment.Ifyouarenotmakingapayment,OregonacceptsthefederalextensionForm7004.WhenyoufileyourForm41,checkthe“Extensiontofile”box.Keepacopyofyourextensioninyourpermanenttaxrecords.
Remember to write a daytime telephone number on your check or money order.
Estate
FORM
41-V
Calendar year:Fiscal year— Begins: Ends:
Tax year (check only one):•
✁Gotowww.oregon.gov/dor/businesstoprintmorevouchers.
• BIN:FEIN:
Filer’s name (on tax return)
Fiduciary’s name
Current mailing address City State ZIP code
Telephone number
12345678-912-3456789
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX XX
XX X
XX
X
XXXXX-XXXX
XX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
X
X
MM/DD/YYYY
XX
MM/DD/YYYY
YYYY
123456789ABCD0000000000000010112020412100
XXX-XXX-XXXX
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