Transcription of Oregon Employee’s Withholding Statement and Exemption ...
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Oregon Employee’s Withholding Statement and Exemption ...
Provide this form to your employer 19612101010000 Oregon Department of Revenue2021 Form OR-W-4 Oregon employee s Withholding Statement and Exemption CertificateOffice use onlyPage 1 of 1, 150-101-402 (Rev. 08-14-20, ver. 01) Employer s nameEmployee s signature (This form isn t valid unless signed.)Social Security number (SSN)Federal employer identification number (FEIN)DateAddressEmployer s addressCityCityStateStateZIP codeZIP codeNote: Your eligibility to claim a certain number of allowances or an Exemption from Withholding may be subject to review by the Oregon Department of Revenue.
Employee’s signature (This form isn’t valid unless signed.) Social Security number (SSN) Federal employer identification number (FEIN) Date Address Employer’s address City City State State ZIP code ZIP code Note: Your eligibility to claim a certain number of allowances or an exemption from withholding may be subject to review by the
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