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The document is a Statement of Account from the Oregon Department of Revenue addressed to Chrissy M Ephrem, detailing a debt of $268.80 owed to Clackamas County Circuit Court. It provides information on payment options and emphasizes the importance of paying the balance to avoid additional penalties and interest. The statement also includes contact information for further assistance.

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27 views2 pages

View File

The document is a Statement of Account from the Oregon Department of Revenue addressed to Chrissy M Ephrem, detailing a debt of $268.80 owed to Clackamas County Circuit Court. It provides information on payment options and emphasizes the importance of paying the balance to avoid additional penalties and interest. The statement also includes contact information for further assistance.

Uploaded by

bobbyjc2405
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Department of Revenue

955 Center St NE
Tina Kotek, Governor Salem, OR 97301-2555
www.oregon.gov/dor

Date: February 7, 2023

CHRISSY M EPHREM Letter ID: L1140840224


14211 BRITTANY TER
OREGON CITY OR 97045-7168

Statement of Account

The enclosed statement of account describes your debt. We're sending this statement in addition to
the notices required by law. The account details shown on the following pages provide a summary
of your accounts and any amounts owed and includes penalties, fees, and interest.

The voucher below shows the balance you owe for the accounts on the following pages. The
amount doesn't include balances you've appealed.

You may pay electronically using Revenue Online at www.oregon.gov/dor. If paying by check,
include the voucher to make sure your payment is applied correctly. To avoid additional penalties
and interest, please pay the balance due immediately.

Your rights in the audit, appeals, and collection processes are explained in Your Rights as an Oregon
Taxpayer, a free publication available online at www.oregon.gov/dor/forms or by calling us.

Please cut along the line and return the bottom portion with your payment.

Form OR-PAY-V, Notice of Amount Due and Payment Voucher


Social Security Number: XXX-XX-9042
Tax type: Other Agency Accounts
150-800-172 (Rev. 10-02-18)

CHRISSY M EPHREM
14211 BRITTANY TER GenTax media #: 20768324803
OREGON CITY OR 97045-7168 Letter ID: L1140840224

Amount due
upon receipt: $268.80
Make check payable to: Oregon Department of Revenue
Send payment and voucher to: PO Box 14730, Salem OR 97309-0464
or visit www.oregon.gov/dor/payments to pay securely right now.

70010000207683248030000000000000999912310000000001
February 7, 2023 Page 2 Letter ID: L1140840224

We're collecting on the following other agency debt. These amounts are contained in the attached
voucher and are detailed below. This statement of account doesn't include disputed debts.

Recent payments may not be reflected in this statement.

Agency CLACKAMAS COUNTY CIRCUIT COURT, OREGON JUDICIAL DEPARTMENT

Reference Period Debt Penalties Interest Refund/Offset Balance


_____________________________________________________________________________________________________________
Dec 27, 2022 $268.80 $0.00 $0.00 $0.00 $268.80
Agency ID number: 20CR18767CLA.
$268.80

Do you have questions or need help?


www.oregon.gov/dor
503-378-4988 or 800-356-4222
questions.dor@oregon.gov
Contact us for ADA accommodations or assistance in other languages.

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