Form Arts 2014 - Arts Income Tax Return
ADVERTISEMENT
1
2ARTS
City of Portland
2014
Revenue Bureau
Arts Income Tax Return
Arts Education and Access Fund
For the year Jan. 1 to Dec. 31, 2014
Due April 15, 2015
OFFICIAL USE ONLY
Portland address that was the primary residence of the taxfilers in 2014. Provide current mailing address if different from residence.
Address (PO Box not allowed)
City
State
Zip Code
Mailing Address (PO Box allowed)
City
State
Zip Code
Does the household qualify for a household poverty exemption (see instructions)?
Yes (verification required)
No
List everyone age 18 and older. If you are claiming a household poverty exemption, list all members of the household, including children.
Name (first, middle, last, suffix)
Birth Year
Income earner: $35 due
Annual taxable income less than $1,000
If “yes” on line 2 list individual annual
Email Address
Social Security Number
income:
$
Name (first, middle, last, suffix)
Birth Year
Income earner: $35 due
Annual taxable income less than $1,000
If “yes” on line 2 list individual annual
Email Address
Social Security Number
income:
$
Name (first, middle, last, suffix)
Birth Year
Income earner: $35 due
Annual taxable income less than $1,000
If “yes” on line 2 list individual annual
Email Address
Social Security Number
income:
$
Name (first, middle, last, suffix)
Birth Year
Income earner: $35 due
Annual taxable income less than $1,000
If “yes” on line 2 list individual annual
Email Address
Social Security Number
income:
$
Name (first, middle, last, suffix)
Birth Year
Income earner: $35 due
Annual taxable income less than $1,000
If “yes” on line 2 list individual annual
Email Address
Social Security Number
income:
$
Calculate balance due.
Arts Tax
Balance
x $35 =
$
___________
Total Amount Due:
Number of income earners: _________
Check #: __________
Due
Sample amounts due: 1 person = $35; 2 people = $70; 3 people = $105; 4 people = $140
Make checks payable to “City of Portland”
Attach required verification documents for all adults who did not pay $35.
I understand that I must provide verification documents (see instructions) for each adult who did not pay $35. Failure to
provide information to support my statement will result in denial of my claim.
Complete your information and mail this form with payment (if any) to the Revenue Bureau.
Send me a paper form next year
Preparer name (printed)
Date
Daytime phone number
Email (if different from above)
Send this form to: Revenue Bureau Arts Tax, PO Box 1278, Portland OR 97207-1278
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial