Form 243 Fillable Claim to Refund Due a Deceased Person
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

Attach a copy of the court appointment if any Attach a copy of the death certificate Check all the boxes (either yes or no) Have claimant sign the form (a) Personal representative of estate (Attach a copy of court appointment ) (b) Responsible party filing affidavit for a small estate (ORS 114 515) (Attach a copy of the affidavit ) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear Form) Clear Form (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) *Social Security number is required for identification purposes OAR 150 305 100 Return this form to: Oregon Department of Revenue 1 Has a personal representative for the estate been appointed by the court? 150 101 032 (Rev 07 10) 150 101 032 (Rev 07 10) Form 243 page 1 of 2 2 Has a small estate affidavit been filed with the county clerk? (ORS 114 515) 3 Has the probate or small estate closed? 4 If the estate is to be probated I am filing this statement as a (check one box only): 5 Does the total due the decedent (except for salary or wages) from all state of Oregon 6 If the estate is not to be probated or probate has closed I qualify for 955 Center Street NE A n hei r of a deceased tax payer must f ile For m 243 to a tax refund on behalf of a deceased taxpayer affidavit has been filed Form 243 is not required agencies exceed $10 000? Americans with Disabilities Act (ADA): Call one of the and a copy of the death certificate if at least six months have are unable to cash it return the check and the completed as indicated on Form 243 Asistencia en espa ol: Attach a photocopy of the death certificate Brothers and/or sisters of the decedent called a living trust) you should be able to cash a refund check issued in the name of the decedent If you are unable check will be issued in the deceased person s name in care Children of the decedent or children of a deceased child of the decedent claim a refund when there is no trustee or court appointed Claim to Refund Due a Deceased Person Claimant s Social Security number Correspondence: court appointment or a copy of the affidavit The refund Date of death Date received deceased person s refund for the estate attach a copy of the Decedent Claimant Decedent s Social Security number* En Salem o fuera de Oregon 503 378 4988 Estate Audit Business Division for Calendar Year For nonprobated or closed estates For nonprobated or closed estates: For office use only For probated estates: Form 243 page 2 of 2 Form 243 with a copy of the death certificate attached The General instructions General tax information www oregon gov/DOR Gratis de prefijo de Oregon 1 800 356 4222 help numbers for information in alternative formats I declare under the penalties of false swearing that the statements herein are true 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 If nonprobated I promise to account fully to other persons entitled to share in this refund I understand that the state of If the court has appointed a personal representative or a smallestate If the personal representative files this form to claim the If you are a trustee of a revocable inter vivos trust (usually If you have received a check in the decedent s name and If you have the original refund check send it back with this form Name of claimant Name of decedent Nephews and/or nieces of the decedent Note: If Yes claimant from number 6 below must claim the refund Note: If Yes the personal representative must claim the refund Note: If Yes the responsible party on the small estate affidavit must claim the refund Note: If Yes you must file a small estate affidavit or open a probate to receive the refund of the personal representative on the return Oregon Department of Revenue Oregon is not responsible for such accounting I declare that there are no family members who are more closely related Parents of the decedent passed since the decedent died payment under one of the following kinship groups (check one box only): personal representative PO Box 14110 Purpose of this form refund check may be reissued in the name of the claimant representative return Staple the form and a copy of the death certificate Revenue finance use only Salem 503 378 4988 Salem area or outside Oregon 503 945 8617 Salem OR 97301 2555 Salem OR 97309 0910 Signature and verification Signature of claimant Telephone number Date State Street address Street address (permanent residence or domicile on date of death) Surviving spouse or registered domestic partner Taxpayer assistance Telephone number To avoid refund delays remember to: to cash the check return it with the completed Form 243 to the decedent to the front of the return below line 8 Mail to the address Toll free from an Oregon prefix 1 800 356 4222 Toll free from an Oregon prefix 1 800 886 7204 Trustee of a revocable inter vivos trust created by the decedent TTY (hearing or speech impaired; machine only): Use Form 243 Claim to Refund Due a Deceased Person to claim What you need to know Who should use this form? X ( ) Yes No Yes No You may file this form at the time you file the decedent's ZIP code