Bin Oregon – Fill Out and Use This PDF

Oregon Combined Payroll Tax

Business Change in Status Form

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To update business status and employment information

Attach additional sheets if needed.

New owner’s name

New owner’s phone

New owner’s address

City

State

ZIP code

Name of leasing company

Worker leasing company license number

Date employees leased

Address

City

Leasing company contact name

Phone

Number of leased employees:

Number of non-leased employees:

Submitted by

Print name

Signature

Title

General updates

NOTE: Some federal employer identification number (FEIN) and name changes may require a new Combined Employer’s Registration, 150-211-055, form to be completed.

•Provide the correct FEIN for your business.

•Correct the business name and spelling errors as needed.

•Check the “Now doing business in TriMet/Lane Transit District” box and include the effective date if you’re an employer paying wages earned in the TriMet or Lane Transit District. You must register and file with the Oregon Department of Revenue. Wages include salaries, commis- sions, bonuses, fees, payments to a deferred compensation plan, or other items of value.

•For boundary questions, see the Oregon Combined Payroll Tax booklet, 150-211-155, for the list of cities and ZIP codes.

——The TriMet district includes parts of Multnomah, Wash- ington, and Clackamas counties. For TriMet boundary questions call 503-962-6466.

——Lane Transit District serves the Eugene-Springfield area. For Lane Transit District boundary questions call 541-682-6100.

Re-opened business

To re-open your business that you’ve closed for:

•Less than one year, file a:

—— Business Change in Status Form, 150-211-156.

•One year or more, file a:

—— Combined Employer’s Registration, 150-211-055.

For more questions contact DOR at 503-945-8091.

Employment status updates

•Check each box that applies to your business and include the effective date of change.

•If Oregon residents are working out of Oregon, indicate which state.

•Check box and indicate effective date of employees now working in Oregon that previously worked in another state.

Using leased employees

If you lease your employees from a Professional Employer Organization (PEO)/Worker Leasing Company, fill in the information requested.

Changing entity

Include the effective date of change, check the box of the entity you’re changing from and the box of the entity chang- ing to.

NOTE: Entity changes require the completion of a new Com- bined Employer’s Registration form.

Examples include, but aren’t limited to:

•Changing from a sole proprietorship to a partnership or corporation.

•Changing from a partnership to a sole proprietorship or corporation.

•Changing from a corporation to a sole proprietorship or partnership.

•Changing of members in a partnership of five or fewer partners.

•Adding or removing a spouse as a liable owner.

•Changing from a sole proprietorship, corporation, or part- nership to a limited liability company.

Owner/officer updates

Attach a separate sheet to update or change corporate officer or owner information.

Compensation for services performed by corporate officers and shareholders is subject to payroll taxes (withholding, transit, and unemployment). If owners and officers are covered by Workers’ Compensation insurance, the hours worked are also subject to Workers’ Benefit Fund (WBF) assessment.

Fax to: 503-947-1700 or

Mail to: Employment Department 875 Union St NE Rm 107 Salem OR 97311-0030

For additional copies of this form, download at: www.oregon.gov/dor/bus or call: 503-947-1488

Closing account

•Check the box if you closed a pension and annuity account. Include the effective date of change.

•Check the “No longer doing business in TriMet/Lane Tran- sit District” box and include the effective date if you moved your business from the TriMet or Lane transit district and are no longer subject to this tax.

•Check the box if you closed the business or dissolved a sole proprietorship, partnership, corporation, or limited liability company, and no longer have payroll to report. Fill in the date of final payroll.

•If you sold your business, leased your employees, or trans- ferred your business assets, indicate whether the transac- tion applied to all or part of the business.

•If you leased all or part of the business, fill out the section “Using Leased Employees.”

NOTE: New or reorganized businesses must complete a Combined Employer’s Registration, 150-211-055, which can be found in pdf format at: www.oregon.gov/dor/bus or elec- tronically at sos.oregon.gov/business.