Payroll Withholding Tax Chart

							                            NRA Tax Withholding Deposit-1042S
                         (for non-payroll tax reporting by OUS Institutions)


     Date Submitted:                                        Tax Year:

 Date of Vendor Pmt:                                    Banner Invoice #:




       Vendor Name:
              Country:

            ITIN/SSN:
     Vendor Address:




                                                                        FOAPAL to be Charged:

    Taxable Amount:                                                         Chart
    % of Withholding:                                                       Index
       *Tax Withheld: $                                      -              Fund

        *Amount to be deposited with IRS                                     Org

                                                                      Account
                                                                     Program


Campus Contact:
Phone #:



Send or Fax this Completed Form to:
                         Jaema Brenneman            Fax: (541) 737-0850
                         Controller's Division      Phone: (541) 737-0824
                         PO Box 488
                         Corvallis, OR 97339-0488