Form 132 - AMENDED Report
/
QTR/YR Changed:
_
Business Identification Number:
BUSINESS NAME:
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Page Totals
Social
Security Number
MAIL TO: OREGON DEPARTMENT OF REVENUE, PO BOX 14800, SALEM OR 97309-0920FAX TO: (503) 947-1700 OR
Preparer Telephone NumberDatePrepared By
Signature
Required X
I certify this report is true and correct and is filed under penalty of false swearing.
First
Initial
Employee Name
Last
Original Whole
Hours as
Reported
Net
Change in
Whole Hours
Correct
Amount of
Whole Hours
Original Wages
as Reported
Net Change
in Wages
Correct Amount
of Wages
Page No. of
REV 06/12
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