Oregon Individual Income Tax Declaration for Electronic Filing

Individual Income Tax Declaration for Electronic Filing
Form OR-EF, Oregon Individual Income Tax Declaration for Electronic Filing, 150-101-339
Clear form

Form OR-EF

Office use only

Page 1 of 2, 150-101-339
(Rev. 08-18-23, ver. 01)

01610001010000

Oregon Department of Revenue

Oregon Individual Income Tax Declaration for Electronic Filing

Tax year
Don’t mail this form to the
Oregon Department of Revenue
First name

Last name

Social Security number (SSN)

Spouse first name

Spouse last name

Spouse SSN

–
–

–
–

Current mailing address
City

State

ZIP code

Phone

(

)

–

Part I—Tax return information	
1.  Net refund (Form OR-40, Form OR-40-N, or Form OR-40-P)............................................................................ 1.
2.  Amount you owe (Form OR-40, Form OR-40-N, or Form OR-40-P)................................................................. 2.

.00
.00

Part II—Direct deposit of refund or direct debit (see instructions)
3.  Routing number

Caution:
Oregon is unable to change account information. Verify that your
banking information is correct. Entering incorrect information will
cause a delay in your refund or rejection of your payment.

4.  Account number
5.  Type of account

Checking  or

Savings

Part III—Declaration of taxpayer(s)
	6a. 	

I consent that my refund be directly deposited as designated in the electronic portion of my Oregon income tax return
(Form OR-40, Form OR-40-N, or Form OR-40-P). If I have filed a joint return, this is an irrevocable appointment of my
spouse as an agent to receive the refund.

	6b. 	

I am receiving a refund but I don’t want to receive it by direct deposit.

	6c. 	

I consent that the return payment is made by direct debit using the account designated above. If I have filed a joint
return, I am authorizing this payment on behalf of my spouse and myself.

	6d. 	

I am not receiving a refund or making an electronic payment.

Under penalties for false swearing, I declare that I have compared the information contained on my return with the information I have provided to
my electronic return originator (ERO) or online service provider (OLSP) and that the amounts described in Part I above agree with the amounts
shown on the corresponding lines of my Oregon income tax return. To the best of my knowledge and belief, my return is true, correct, and
complete. I consent that my return, including this declaration and accompanying schedules and statements, be forwarded upon request to
the Oregon Department of Revenue (DOR) by my ERO or OLSP. If the processing of my return, payment, or refund is delayed, I authorize the
department to disclose to my preparer the reason(s) for the delay and the date the payment was posted to my account or the refund was sent.
Sign
here

Your signature

Date

Spouse signature (if filing jointly, both must sign)

Date

➤X
X

/

/

/

/

Form OR-EF
Page 2 of 2, 150-101-339
(Rev. 08-18-23, ver. 01)

01610001020000

Oregon Department of Revenue

Part IV—Declaration of electronic return originator (ERO) or paid preparer
I declare that I have reviewed the above taxpayer’s return and that the entries on this form are complete and correct to the best of my knowledge. If I
am only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects data on the return. The taxpayer will
have signed this form before I submit the return. I will give the taxpayer a copy of all forms and information to be filed with Oregon, and have followed all
other requirements described in the Modernized Electronic Filing Handbook for Software Developers and Tax Preparers. If I am also the paid preparer,
under penalty of perjury I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best of
my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

Electronic return originator’s use only
ERO signature

Date

X

/

Check if
paid preparer

/

Firm name (or your name, if self-employed)

Phone

(
ERO address

Check if
self-employed
ERO license number

)

–

City

State

ZIP code

Under penalty of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best
of my knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.

Paid preparer’s use only
Date

Preparer signature

X

/

Check if
self-employed

/
Phone

Firm name (or yours if self-employed)

(
Preparer address

City

Certificate/license number

)

–
State

Don’t mail this form or your paper return to the Oregon Department of Revenue

ZIP code