pdf2json/test/data/or/form/VOUCH.content.txt

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150-101-172 (Rev. 12-13)
Oregon Income Tax Payment Voucher, Form 40-V
OREGON INCOME TAX PAYMENT VOUCHER
Department of Revenue Use Only
•
FORM
40-V
Enter Payment Amount
$
.
0  0
•
Fiscal Year Ending
Payment Type 
(check only one):
2013 
Return 
Amended--Tax Year:
Last name
First name and initial
Spouse’s/RDP’s last name if joint payment
Spouse’s/RDP’s first name and initial 
Current mailing address
City
SSN
Spouse’s/RDP’s SSN if joint payment
State      ZIP code
First time Oregon filer
New name or address
Daytime telephone number:
Check if:
Detach Here
➤
Detach Here
➤
Where to mail 
If you filed your return:            Mail to:
On paper
PO Box 14555 
Salem OR 97309-0940
With a 2-D barcode or 
electronically
PO Box 14720
Salem OR 97309-0463
Don’t use Form 40-V if you are using an electronic payment option.
Use the voucher only if you are paying by check or money order.
Complete the form below using your computer.
After you have printed it, cut along the dotted line and 
mail to the Department of Revenue at the addresses shown above.
Note:
If, when typing, you see a solid box instead of letters or numbers,  
adjust the view size to 100 percent. If the letters or numbers still are not visible,  
press the tab key.
(Not Supported)
Prior Tax Year:
(Not Supported)
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