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Form Forest Products Harvest Tax Return Department use only <br /> •201 :ate received <br /> FP Payment amount I <br /> •2015 • <br /> 1 2 3 <br /> • • • <br /> • Business identification number(BIN) 502090-6 <br /> •❑No harvest — Check here,sign, <br /> and return form. <br /> •❑Amended return <br /> CITY OF EUGENE <br /> 1820 ROOSEVELT BLVD •❑Another party Is responsible <br /> EUGENE OR 97402 (attach copy of contract) <br /> Do not white-out,cross-out,or change printed information on the return.Attach a separate explanation of changes. <br /> 1 2 3 4 6 e 7 8 <br /> • Nottttcailon of operations number Landowner Township Range Sea <br /> Operator sale name/contract number County N or S E or W !bon • Volume(MBF) <br /> 2015-781-09971-01 MG Land Improvem City of Eugene/M 20 188 4W 04 14-4) , %M7 <br /> 2015-781-10719-01 Integrated Resou Emily Steel/City 20 188 4W 03 3(.0,q.0 <br /> Please attach a copy of any additional notification(s)ofTotal volume 9 <br /> • <br /> operations that are not printed on this form. (Total amounts from column 8 on all pages)• I -1--. CA.) <br /> 10 <br /> Make check or money order payable to: 25 MBF exemption — 25 MBF <br /> Oregon Department of Revenue Taxable volume 11 <br /> (Box 9 minus box 10.If less than zero,enter zero) • 15 2. OD <br /> Tax 12 <br /> Mail to: Timber Tax Programs • �" Q� <br /> (Multiply amount In box 11 x$3.6318) J-)v' A W <br /> Oregon Departm of Revenue 13 <br /> PO Box 14003 s Estimated or Prior Payments for 2015• <br /> Salem OR 97309-2502 • A <br /> Tax due with this return 14 <br /> (Subtract box 13 from box 12) •53(p Aso <br /> Declaration: Under penalties for false swearing, I declare that 18 <br /> Overpayment <br /> I have examined this return, including accompanying schedules • <br /> A <br /> and statements, and to the best of my knowledge and belief it's Up to 3 months late,enter 0.05 x box 14 1e <br /> true,correct,and complete. Penalty rr Over 3 months late,enter 0.26 x box 14 <br /> Slgnature(s) ) 17 <br /> x , i Interest• Number t...1......,..s e--i.4of days latex 0.000110 x box 14 <br /> Phone 'L �` ZTotal payment ,�� <br /> —ZL ! U) / — $ Zi�' (Add boxes 14,16.and 17) 5 <br /> f 7/ 2i ti. �Jll <br /> -Keep a copy of this return for your records — <br /> 150-502-201(Rev.07.16) <br />