Form TCA Fillable Tax Credit Auction Bidder Information and Agreement Form
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Mail it early enough to ensure it s received by January 24 Send it to the address below to ensure it receives expedited (including any accompanying statements) and to the best of my knowledge it is true correct and complete (text) (text) (text) (text) (text) (text) (text) (text) (text) 1155 S 5th Street Suite A 119 4th Street NE #4 1550 NW Eastman Parkway Suite 220 1600 Valley River Drive Suite 310 17 2014 and a completed Form TCA with your payment must be received in a Department of Revenue office by 5 p m PDT 2 Bid amount per certificate in multiples of $1 (must be at least $475) 2 2 Complete Form TCA (this form) for each bid you submit 2014 tax return can be carried forward for up to 3 years Tax credit certificates will be mailed to the prevailing bids at the 2014; and 3 Payment due (line 1 multiplied by line 2) 3 3613 Aviation Way Suite 102 4 Deliver the payment and a completed Form TCA to us by 5 p m PDT January 17 2014 to submit your bid Keep a 5 p m PDT January 24 2014 700 SE Emigrant Suite 310 800 NE Oregon Street 5th floor 951 SW Simpson Avenue Suite 100 955 Center Street Room 135 A bidder may submit multiple bids A separate payment and Form TCA must be completed for each bid accepted and your bid will not be considered address is correct) address listed on this form Americans with Disabilities Act (ADA): Call one of the help Asistencia en espa ol: Attention: Tax Credit Auction Authorized signature Bank issued cashier s checks bank issued certified checks or money orders made payable to Oregon Department of be charged to cancel your payment if it is returned to you bid will not be considered in the auction Bidder information and agreement form Bidder name (if a business use business name) Bidding Instructions for Form TCA Bidding steps Businesses: Federal employer identification number (FEIN) or Oregon business identification number (BIN) Cash personal checks and wire transfers are not acceptable cashier s checks or money orders made payable to certificates than bid Contact information Contact name (for businesses only) Coos Bay copy of the online confirmation for your records Date and time bid submitted (see confirmation) Daytime telephone number Deadlines DECLARATION delivered to any Department of Revenue office Warning! If Determine your payment This information must match the bid you submitted online E mail: taxcreditauction@dor state or us Email address En Salem o fuera de Oregon 503 378 4988 enforced Please take care to ensure that both the bidding and Eugene for the full amount of the bid (see Payments below) forms of payment They will be returned to you and your General tax information www oregon gov/dor Go to www oregon gov/dor/pertax/pages/creditauction Gratis de prefijo de Oregon 1 800 356 4222 Gresham Have questions? Need help? I declare under the penalties for false swearing [ORS 305 990(4)] that I have examined understand and agree to the rules in this document If the associated bid does not result in the issuance of a tax credit certificate payment will be returned to the bidder at the If there is a tie the tax credit certificate will be issued to the bid received first It is possible that a bidder may receive fewer If you re using a money order we recommend that you use If your bid is not successful we ll return your payment to Important! Please read all instructions You must submit your bid online first This form must be received with your Individuals: Last four digits of Social Security number (SSN) info aspx between 9 a m January 13 2014 and January 24 2014 Postmarks will not be considered and we can t guarantee that any mailed payments will be received by Mail payments to: Mailing address Medford Name (please print or type) Date Newport Number of certificates you re bidding on 1 numbers above for information in alternative formats Obtain payment (certified check cashier s check or money of Revenue make sure you: of these Department of Revenue locations: Once a bid is submitted it cannot be changed or revoked order made payable to Oregon Department of Revenue) Oregon Department of Revenue Oregon Department of Revenue as valid forms of payment Oregon Tax Credit Auction Page 1 of 2 Page 2 of 2 PART A Bidder information PART B Payment PART C Auction rules payment by 5 p m PDT January 24 2014 Complete this form for each bid you submit payment deadlines are met Payments may be personally Payments Pendleton Please verify the procedures and possible fees that you may PO Box 14600 Portland Read the auction rules carefully Sign the form to acknowledge Revenue are the only acceptable forms of payment Personal checks credit cards wire transfers and cash will not be Salem Salem 503 378 4988 Salem area or outside Oregon 503 945 8617 Salem OR 97309 5049 State Tax Credit Auction Tax year that you understand and agree to the rules the address on Form TCA (please verify that your return The auction bidding and payment deadlines will be strictly The credit can be claimed on your 2013 or 2014 tax return Any amount that cannot be used on your 2013 or the deadline the money order the U S Postal Service because the USPS can easily re issue To be considered in the auction a bid must be submitted online between 9 a m January 13 2014 and 5 p m PDT January Toll free from an Oregon prefix 1 800 356 4222 Toll free from an Oregon prefix 1 800 886 7204 treatment Remember postmarks do not count TTY (hearing or speech impaired; machine only): We will issue up to 1 892 tax credit certificates (each worth $500) to the highest qualifying bids The credits are nontransferable We will only accept bank issued certified checks bankissued www oregon gov/dor/pertax/pages/credit auction info aspx you mail your payment and Form TCA to the Department You may hand deliver your payment and Form TCA to any ZIP code