Form OR-150-101-032 (OR-243) "Claim to Refund Due a Deceased Person" - Oregon

Form OR-150-101-032 or the "Form Or-243 - Claim To Refund Due A Deceased Person" is a form issued by the Oregon Department of Revenue.

Download a PDF version of the Form OR-150-101-032 down below or find it on the Oregon Department of Revenue Forms website.

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Download Form OR-150-101-032 (OR-243) "Claim to Refund Due a Deceased Person" - Oregon

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Clear form
Form OR-243
Office use only
00410001010000
Date received
Page 1 of 1, 150-101-032 (Rev. 12-18)
Oregon Department of Revenue
Claim to Refund Due a Deceased Person
Submit original form—do not submit photocopy
For calendar year
Decedent
Claimant
Name of decedent
Name of claimant
Date of death
Decedent’s Social Security number (SSN)
Claimant’s SSN
Phone
/
/
(
)
Street address (permanent residence or domicile on date of death)
Street address
City
State
ZIP code
City
State
ZIP code
1. Has a personal representative for the estate been appointed by the court? ......................................... 1.
Yes
No
If “Yes,” the personal representative must claim the refund.
2. Has a small-estate affidavit been filed with the county clerk? ................................................................2.
Yes
No
If “Yes,” the responsible party on the small-estate affidavit must claim the refund.
3. Has the probate or small estate closed? .................................................................................................3.
Yes
No
If “Yes,” claimant from number 6 below must claim the refund.
4. If the estate is to be probated, I am filing this statement as a (check one box only):
(a)
Personal representative of estate. (Attach a copy of court appointment.)
(b)
Responsible party filing affidavit for a small estate. (Attach a copy of the affidavit.)
For nonprobated or closed estates
5. Does the total due the decedent (except for salary or wages) from all state of Oregon
agencies exceed $10,000? ......................................................................................................................5.
Yes
No
If “Yes,” you must file a small-estate affidavit or open a probate to receive the refund.
6. If the estate isn’t to be probated or probate has closed, I qualify for payment under
one of the following kinship groups (check one box only):
Revenue Finance use only
Surviving spouse or registered domestic partner.
_______________________________________________
Trustee of a revocable inter vivos trust created by the decedent.
_______________________________________________
Children of the decedent or children of a deceased child of the decedent.
_______________________________________________
Parents of the decedent.
Brothers and/or sisters of the decedent.
Nephews and/or nieces of the decedent.
Attach a photocopy of the death certificate.
If you have the original refund check, send it back with this form.
Signature and verification
I promise to use all of the money to pay the expenses of the last illness and funeral of the decedent if necessary. If, after payment of
the check by the state treasurer, the decedent’s estate is probated, I promise to account fully to the personal representative.
If nonprobated, I promise to account fully to other persons entitled to share in this refund. I understand that the state of Oregon isn’t
responsible for such accounting. I declare that there are no family members who are more closely related to the decedent.
I declare under the penalties of false swearing that the statements herein are true.
Signature of claimant
Phone
Date
(
)
/
/
X
Return this form to: Oregon Department of Revenue, 955 Center Street NE, Salem OR 97301-2555
Clear form
Form OR-243
Office use only
00410001010000
Date received
Page 1 of 1, 150-101-032 (Rev. 12-18)
Oregon Department of Revenue
Claim to Refund Due a Deceased Person
Submit original form—do not submit photocopy
For calendar year
Decedent
Claimant
Name of decedent
Name of claimant
Date of death
Decedent’s Social Security number (SSN)
Claimant’s SSN
Phone
/
/
(
)
Street address (permanent residence or domicile on date of death)
Street address
City
State
ZIP code
City
State
ZIP code
1. Has a personal representative for the estate been appointed by the court? ......................................... 1.
Yes
No
If “Yes,” the personal representative must claim the refund.
2. Has a small-estate affidavit been filed with the county clerk? ................................................................2.
Yes
No
If “Yes,” the responsible party on the small-estate affidavit must claim the refund.
3. Has the probate or small estate closed? .................................................................................................3.
Yes
No
If “Yes,” claimant from number 6 below must claim the refund.
4. If the estate is to be probated, I am filing this statement as a (check one box only):
(a)
Personal representative of estate. (Attach a copy of court appointment.)
(b)
Responsible party filing affidavit for a small estate. (Attach a copy of the affidavit.)
For nonprobated or closed estates
5. Does the total due the decedent (except for salary or wages) from all state of Oregon
agencies exceed $10,000? ......................................................................................................................5.
Yes
No
If “Yes,” you must file a small-estate affidavit or open a probate to receive the refund.
6. If the estate isn’t to be probated or probate has closed, I qualify for payment under
one of the following kinship groups (check one box only):
Revenue Finance use only
Surviving spouse or registered domestic partner.
_______________________________________________
Trustee of a revocable inter vivos trust created by the decedent.
_______________________________________________
Children of the decedent or children of a deceased child of the decedent.
_______________________________________________
Parents of the decedent.
Brothers and/or sisters of the decedent.
Nephews and/or nieces of the decedent.
Attach a photocopy of the death certificate.
If you have the original refund check, send it back with this form.
Signature and verification
I promise to use all of the money to pay the expenses of the last illness and funeral of the decedent if necessary. If, after payment of
the check by the state treasurer, the decedent’s estate is probated, I promise to account fully to the personal representative.
If nonprobated, I promise to account fully to other persons entitled to share in this refund. I understand that the state of Oregon isn’t
responsible for such accounting. I declare that there are no family members who are more closely related to the decedent.
I declare under the penalties of false swearing that the statements herein are true.
Signature of claimant
Phone
Date
(
)
/
/
X
Return this form to: Oregon Department of Revenue, 955 Center Street NE, Salem OR 97301-2555
General instructions
Purpose of this form
OR-243 with a copy of the death certificate attached. The
refund check may be reissued in the name of the claimant
Use Form OR-243 to claim a tax refund on behalf of a
as indicated on Form OR-243.
deceased taxpayer.
For probated estates
Who should use this form?
If the personal representative files this form to claim the
An heir of a deceased taxpayer must file Form OR-243 to
deceased person’s refund for the estate, attach a copy of the
claim a refund when there is no trustee or court appointed
court appointment or a copy of the affidavit. The refund
representative.
check will be issued in the deceased person’s name, in care
of the personal representative.
If the court has appointed a personal representative, or
a small-estate affidavit has been filed, Form OR-243 isn’t
To avoid refund delays, remember to
required.
• Answer each question on Form OR-243.
If you are a trustee of a revocable inter vivos trust (usually
• Attach a copy of the death certificate.
called a living trust), you should be able to cash a refund
• Attach a copy of the court appointment, if any.
check issued in the name of the decedent. If you are unable
• Have claimant sign the form.
to cash the check, return the check with the completed Form
OR-243 and a copy of the death certificate if at least six
Do you have questions or need help?
months have passed since the decedent died.
www.oregon.gov/dor
What you need to know
(503) 378-4988 or (800) 356-4222
questions.dor@ oregon.gov
For nonprobated or closed estates
If you have received a check in the decedent’s name and are
Contact us for ADA accommodations or assistance in other
unable to cash it, return the check and the completed Form
languages.
150-101-032 (Rev. 12-18)
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