IN THE OREGON TAX COURT REGULAR DIVISION Income Tax ___________________________________, ___________________________________, Plaintiff(s), v. DEPARTMENT OF REVENUE, State of Oregon, Defendant. ) ) ) TC No. ______ (court use only) ) ) ) ) ) ) ) COMPLAINT Plaintiff(s) alleges: (1) Defendant either assessed additional income taxes, penalties, and interest against (2) Plaintiff(s) appealed the assessment or denial of refund to the Magistrate Division of the Oregon Tax Court. The magistrate issued a written decision, a copy of which is attached as Exhibit A. _____________________________________________________________________________. (4) Plaintiff(s) has paid any taxes, penalties, and interest Defendant claims is owing for such tax years. (If not, Plaintiff(s) alleges that it would be an undue hardship to do so and has attached a Motion for Stay of Payment of Income Tax and Affidavit of Undue Hardship.) THEREFORE, Plaintiff(s) asks this court for a judgment declaring that ______________ _____________________________________________________________________________. _____________________________________ _____________________________________ _____________________________________ _____________________________________ Signature Signature _____________________________________ Mailing Address _____________________________________ City, State, Zip _____________________________________ Telephone Number (daytime) _____________________________________ Email Address Rev. 01-11 COMPLAINT Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com