
150-211-156 (Rev. 07-08-2024)
Oregon Combined Payroll Tax
Business Change in Status Form
To Update Business Status and Employment Information
Attach additional sheets if needed.
Business name
Other names (ABN/DBA)
BIN (Oregon business identification number)
FEIN (Federal employer identification number)
General updates (check all that apply)
Owner/Officer updates:
To update owner/officer informa-
tion, attach a complete list of
current owners/officers including
position, social security number
(SSN), home address, and phone.
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:
No longer doing business in TriMet/Lane Transit District as of:
All or
Closed No longer doing business in Oregon Sold Leased Transferred
Was business operating at the time it was sold, leased or transferred?
Yes No
How many employees were transferred?
Effective date:
Date of final payroll:
Describe what was transferred
New business name
New owner’s name
New owner’s address
Where are the records of the terminated business? (Include contact name, phone, address, city, state, ZIP code)
New owner’s phone
Changing entity (check all that apply)
Effective date:
Note: A new Combined Employer’s Registration form, 150-211-055, is required when there is an entity change.
Change
from:
Change
to:
Corporation —“C” Corporation—Subchapter “S”
Individual (Sole Proprietor)
Partnership —General Partnership—Limited
LLP (Limited Liability Partnership)
Corporation Sole Proprietor/Single Member Partnership
LLC (Limited Liability Company) Recognized by IRS as:
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 have workers’ compensation insurance
to cover owners, officers or members.
Only LLC members or officers
Courtesy withholding
Only using independent contractors
Employing Oregon residents in another state. State: Now working in Oregon. Effective date:
Using leased employees
Authorization
Name of leasing company
Leasing company contact name
Address City
City
State
State
ZIP code
ZIP code
Phone
Date employees leased
Number of leased employees:
Worker leasing company license number
Number of non-leased employees: Leasing corporate officers/owners?
Yes
No
Fax to: 503-947-1700 or mail to: Employment Department, 875 Union St NE Rm 107, Salem OR 97311-0030
Signature
Print name Title
Date Phone
Corporation —“C” Corporation—Subchapter “S”
Individual (Sole Proprietor)
Partnership —General Partnership—Limited
LLP (Limited Liability Partnership)
Corporation Sole Proprietor/Single Member Partnership
LLC (Limited Liability Company) Recognized by IRS as:
Part
of the business was
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)