150-101-172 (Rev. 12-13)

Oregon Income Tax Payment Voucher, Form 40-V

OREGON INCOME TAX PAYMENT VOUCHERDepartment of Revenue Use Only

•

FORM40-V

Enter Payment Amount

$.0  0

•Fiscal Year EndingPayment Type (check only one):

2013 Return Amended--Tax Year:

Last nameFirst name and initial

Spouse’s/RDP’s last name if joint paymentSpouse’s/RDP’s first name and initial 

Current mailing addressCity

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 paperPO 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)

----------------Page (0) Break----------------