Oregon Combined Payroll Tax Business Change in Status Form

Combined Payroll Tax Business Change in Status Form
Oregon Combined Payroll Tax Business Change in Status Form, 150-211-156
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Oregon Combined Payroll Tax

Business Change in Status Form

To Update Business Status and Employment Information
Attach additional sheets if needed.

Business name

BIN (Oregon business identification number)

Other names (ABN/DBA)

FEIN (Federal employer identification number) tion, attach a complete list of

Owner/Officer updates:
To update owner/officer informacurrent owners/officers including
position, social security number
(SSN), home address, and phone.

General updates (check all that apply)
Update/Change FEIN to:

Update/Change business name to:

Now doing business in TriMet/Lane
Transit District as of:

Closing account (check all that apply)
Closed pension/annuity account as of:
All or
Part of the business was

No longer doing business in TriMet/Lane Transit District as of:

Closed

No longer doing business in Oregon
Sold
Yes
No Effective date:
Date of final payroll:

Leased

Transferred

Was business operating at the time it was sold, leased or transferred?
How many employees were transferred?
Describe what was transferred
New business name
New owner’s name

New owner’s phone

New owner’s address

City

State

ZIP code

Where are the records of the terminated business? (Include contact name, phone, address, city, state, ZIP code)

Changing entity (check all that apply)
Effective date:
Change
from:
Change
to:

Note: A new Combined Employer’s Registration form, 150-211-055, is required when there is an entity change.
Corporation­—“C”
Corporation—Subchapter “S”
Individual (Sole Proprietor)
Partnership­—General
Partnership—Limited

LLC (Limited Liability Company) Recognized by IRS as:
Corporation­
Sole Proprietor/Single Member
Partnership

LLP (Limited Liability Partnership)

Corporation­—“C”
Corporation—Subchapter “S”
Individual (Sole Proprietor)
Partnership­—General
Partnership—Limited

LLC (Limited Liability Company) Recognized by IRS as:
Corporation­
Sole Proprietor/Single Member
Partnership

LLP (Limited Liability Partnership)

Employment status updates (check all that apply)
Still in business, but have no paid employees (corporate officers are still subject to payroll taxes). Effective date:
Only LLC members or officers
Only using independent contractors
Only have workers’ compensation insurance
to cover owners, officers or members.
Courtesy withholding
Employing Oregon residents in another state.

State:

Now working in Oregon.

Effective date:

Using leased employees
Name of leasing company

Worker leasing company license number

Date employees leased

Address

City

State

Leasing company contact name

Phone

Number of leased employees:

Authorization

Number of non-leased employees:

ZIP code

Leasing corporate officers/owners?

Yes

No

Under penalties of false swearing, I declare that the information on this form, including accompanying documents, is true, correct,
and complete to the best of my knowledge and belief. (ORS 305.810)

Print name

Title

Signature

Date

Phone

Fax to: 503-947-1700 or mail to: Employment Department, 875 Union St NE Rm 107, Salem OR 97311-0030
150-211-156 (Rev. 07-08-2024)