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11410 SW 68th Parkway, Tigard OR 97223 Mailing Address PO Box 23700, Tigard OR 97281-3700 Toll free 888-320-7377 fax 503-598-0561 Website http://oregon.gov/pers Tax Withholding Form for IAP Rollover-Eligible
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This form is strictly for reporting income and tax information.
Any individual or entity that received income during the tax year.
The form must be filled out accurately and completely, including all relevant income information.
The purpose of this form is strictly to report income to the tax authorities.
All income received during the tax year must be reported on this form.
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