Form OR-21-V — Oregon Pass-through Entity Elective Tax Payment Voucher

Pass-through Entity Elective Tax Payment Voucher
Clear form
Oregon Department of Revenue

• Use UPPERCASE letters. • Use blue or black ink. • Print actual size (100%). • Don't submit photocopies or use staples.

Tax year beginning (MM/DD/YYYY) Tax year ending (MM/DD/YYYY)
/ / / /
Pass-through entity legal name
Contact first name Initial
Contact last name
Federal employer identification number (FEIN)
Current address
City
Contact phone
Want to make your payment online? Find options at www.oregon.gov/dor.
Use this voucher only if you're making a payment without Form OR-21 and you're not paying online. For more information, see Form OR-21-V Instructions.
Make your check, money order, or cashier's check payable to the Oregon
Department of Revenue. Don't mail cash. Write the tax year, "Form OR-21-V," contact name, daytime phone, and the entity's FEIN on the payment. Mail the payment and voucher to:
Oregon Department of Revenue
PO Box 14950
Salem OR 97309-0950
(Rev. 04-23-25, ver. 04)
State ZIP code
Payment type (check one)
Original return or extension
Estimated payment
Amended return
Enter payment amount
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$