150-211-156 (Rev. 12-16)
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
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
Submitted by
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
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150-211-156 (Rev. 12-16)
Business Change in Status Form Instructions
Use this form to notify the Employment Department (OED), Department of Revenue (DOR), and Department of Consumer
and Business Services (DCBS) of changes to your business or employment status. Attach additional sheets if needed.
General updates
NOTE: Some federal employer identification number (FEIN)
and name changes may require a new Combined Employers
Registration, 150-211-055, form to be completed.
Provide the correct FEIN for your business.
Correct the business name and spelling errors as needed.
Check the “Now doing business in TriMet/Lane Transit
District” box and include the effective date if you’re an
employer paying wages earned in the TriMet or Lane
Transit District. You must register and file with the Oregon
Department of Revenue. Wages include salaries, commis-
sions, bonuses, fees, payments to a deferred compensation
plan, or other items of value.
For boundary questions, see the Oregon Combined Payroll
Tax booklet, 150-211-155, for the list of cities and ZIP codes.
The TriMet district includes parts of Multnomah, Wash-
ington, and Clackamas counties. For TriMet boundary
questions call 503-962-6466.
Lane Transit District serves the Eugene-Springfield
area. For Lane Transit District boundary questions call
541-682-6100.
Re-opened business
To re-open your business that you’ve closed for:
Less than one year, file a:
Business Change in Status Form, 150-211-156.
One year or more, file a:
Combined Employers Registration, 150-211-055.
For more questions contact DOR at 503-945-8091.
Owner/officer updates
Attach a separate sheet to update or change corporate officer
or owner information.
Compensation for services performed by corporate officers
and shareholders is subject to payroll taxes (withholding,
transit, and unemployment). If owners and officers are
covered by Workers’ Compensation insurance, the hours
worked are also subject to Workers’ Benefit Fund (WBF)
assessment.
Employment status updates
Check each box that applies to your business and include
the effective date of change.
If Oregon residents are working out of Oregon, indicate
which state.
Check box and indicate effective date of employees now
working in Oregon that previously worked in another state.
Using leased employees
If you lease your employees from a Professional Employer
Organization (PEO)/Worker Leasing Company, fill in the
information requested.
Changing entity
Include the effective date of change, check the box of the
entity you’re changing from and the box of the entity chang-
ing to.
NOTE: Entity changes require the completion of a new Com-
bined Employers Registration form.
Examples include, but aren’t limited to:
Changing from a sole proprietorship to a partnership or
corporation.
Changing from a partnership to a sole proprietorship or
corporation.
Changing from a corporation to a sole proprietorship or
partnership.
Changing of members in a partnership of five or fewer
partners.
Adding or removing a spouse as a liable owner.
Changing from a sole proprietorship, corporation, or part-
nership to a limited liability company.
Closing account
Check the box if you closed a pension and annuity account.
Include the effective date of change.
Check the “No longer doing business in TriMet/Lane Tran-
sit District” box and include the effective date if you moved
your business from the TriMet or Lane transit district and
are no longer subject to this tax.
Check the box if you closed the business or dissolved a
sole proprietorship, partnership, corporation, or limited
liability company, and no longer have payroll to report.
Fill in the date of final payroll.
If you sold your business, leased your employees, or trans-
ferred your business assets, indicate whether the transac-
tion applied to all or part of the business.
If you leased all or part of the business, fill out the section
“Using Leased Employees.”
NOTE: New or reorganized businesses must complete a
Combined Employers Registration, 150-211-055, which can be
found in pdf format at: www.oregon.gov/dor/bus
or elec-
tronically at
sos.oregon.gov/business
.
Fax to: 503-947-1700 or
Mail to: Employment Department
875 Union St NE Rm 107
Salem OR 97311-0030
For additional copies of this form, download at:
www.oregon.gov/dor/bus or call: 503-947-1488