150-101-172 (Rev. 07-17-19, ver. 02)
Oregon Department of Revenue
Form OR-40-V
Oregon Individual Income Tax Payment Voucher and Instructions
Page 1 of 1, 150-101-172
(Rev. 07-17-19, ver. 02)
Begins:
Ends:
•
Tax year:
SSN
SSN
Current mailing address
City State Contact phoneZIP code
Enter payment amount
$
Form OR-40-V, Oregon Individual Income Tax Payment Voucher
Office use only
•
•
Payment type (check only one):
Estimated payment
Extension payment
Amended return
Original return
Cut on dashed line below to detach voucher. Visit www.oregon.gov/dor/forms to print more vouchers.
First name Last nameInitial
Spouse’s first name Spouse’s last nameInitial
Online payments:
You can make payments anytime at www.oregon.gov/dor. Don’t use Form OR-40-V with online payments.
Payments with a return:
If you’re mailing a payment with your tax return, send the payment and return in the same envelope and don’t use Form
OR-40-V. We accept checks, money orders, and cashier’s checks. Don’t mail cash. See the instructions for the return you
are filing for the mailing address to send your return and payment.
Payments without a return:
If you’re mailing a payment without a return, mail your check, money order, or cashier’s check with Form OR-40-V to:
Oregon Department of Revenue
PO Box 14950
Salem OR 97309-0950
Write “2019 Form OR-40-V” and the last four digits of your SSN or ITIN on your check.
Form OR-40-V instructions
Tax year. Enter the month, day, and year for the beginning and end date of the tax year you are submitting the payment
for. For most filers this will be January 1 through December 31 of the tax year. Example: For tax year 2019, enter:
Begins: 01/01/2019. Ends: 12/31/2019.
Payment type. Check the appropriate box for the type of payment being made.
Taxpayer information. Completely fill out the information on the form. If your address has changed since the last time
you filed a return, complete a Change of Address/Name form and mail it to us. Your address will not be updated using
information on Form OR-40-V.
Note: If you are viewing this form electronically and you see a solid box instead of letters or numbers, adjust the view size
to 100 percent and press the tab key to move through the fields.
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