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5           Form OR-DECD-TAX                                                                                                                        Office use only                                      5
6           Page 1 of 1, 150-101-151                     Oregon Department of Revenue                   01340001010000                        Date received                                              6
7           (Rev. 08-01-22, ver. 01)                                                                                                                                                                     7
8           Final Tax and Discharge of a Decedent’s Estate                                                                                                                                               8
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11                                                                 Submit original form—do not submit photocopy                                                                                          11
12          Important: Mail this form separately from your tax return.                                                                                                                                   12
13          Oregon probate number (if probated)     County of probate                                                                    Federal employer identification number (FEIN)                   13
14          XXXXXXXXXXXXXXXXX                       XXXXXXXXXXXXXXXXXXXXXXXXX                                                            99-9999999                                                    14
15          Decedent first name          Initial Last name                                         Date of death                         Social Security number (SSN)                                    15
16          XXXXXXXXXXXX X                       XXXXXXXXXXXXXXXXXXXX99/99/9999/                        /                                999-99-9999                                                 16
17          Spouse first name            Initial Last name                                         Date of death (if spouse is deceased) Spouse SSN                                                      17
18          XXXXXXXXXXXX X                       XXXXXXXXXXXXXXXXXXXX99/99/9999/                        /                                999-99-9999                                                 18
19          Decedent last permanent address                                                        City                                       State ZIP code                                             19
20                                                                                                                                                                                                       20
21          PersonalXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXrepresentative first nameInitial Last name XXXXXXXXXXXXXXXXXXXXXPersonal representativeXXdaytimeXXXXX-XXXXphone                                   21

22          XXXXXXXXXXXX                         X       XXXXXXXXXXXXXXXXXXXX                                      (999)(   )            999-9999                                                      22
23          Personal representative current address                                                City                                       State ZIP code                                             23
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            XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                   XXXXXXXXXXXXXXXXXXXXX                       XX    XXXXX-XXXX
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26           X Check this box for: Final tax of a decedent’s estate                                                                                                                                      26
27             I certify that I represent the estate named above. I elect a final tax determination for the income tax returns and years listed below that                                               27
28             have been filed during the period of estate administration [Oregon Revised Statute (ORS) 316.387]. A copy of the inventory of probated and                                                28
29             nonprobated assets of the decedent’s gross estate is included with the decedent’s final return, first fiduciary return, or with this election form if                                     29
30             a return is not required to be filed.                                                                                                                                                     30
             
31             I understand the department may issue a notice of deficiency, within 18 months after the filing of this election (ORS 305.265). I further                                                 31
32             understand that if the department fails to issue a notice of deficiency within the 18 month period, the statute of limitations for the returns covered                                    32
33             by this election will expire, unless the department finds that: (a) gross income equal to 25 percent or more of the gross income reported has                                             33
34             been omitted from a return; (b) false or fraudulent returns were filed; (c) no returns were filed, but returns were required to be filed; or (d) if the                                   34
               department receives a correction to the decedent’s or decedent’s estate income tax from the Commissioner of the Internal Revenue Service.
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36             I understand the department won’t reply to this election, except by issuing a notice of deficiency, and that I may choose to close the estate                                             36
37             administration at the earliest date allowed, even though the period for issuing a notice of deficiency hasn’t expired. I also understand that if the                                      37
38             estate is closed and the assets distributed prior to the expiration of the time for giving a notice of deficiency, and the department then issues a                                       38
               notice of deficiency, the transferees of the estate’s money or property are liable for the tax liability.
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41           X Check this box for: Discharge of a decedent’s estate                                                                                                                                      41
42             I hereby apply for a discharge from personal liability for tax on income of the above named decedent (ORS 316.387). I certify that I represent                                            42
43             the decedent in a fiduciary capacity as personal representative, administrator, trustee, or other fiduciary title. I have included a copy of the                                          43
44             document showing my appointment.                                                                                                                                                          44
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               I understand the department won’t reply to this election.
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47             I understand that this discharge becomes effective:                                                                                                                                       47
48             •  After the filing of the decedent’s final tax return or any tax returns required to be filed, and the payment of any tax of which I am notified; or                                     48
49             •  Nine months after receipt of this application by the Oregon Department of Revenue, and during which time no notification of tax liability is made.                                     49
             
50             I understand that a discharge doesn’t discharge me from liability to the extent that assets of the decedent’s estate are still in my possession or                                        50
51             control (ORS 316.387).                                                                                                                                                                    51
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53                                                                                                                                                                                                       53
54          These requests are for the following tax returns, check the box or boxes that apply, and enter the tax year(s):                                                                              54
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56           X Individual income tax: For tax year(s) ______________________________________________________________________________________________XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 56
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58           X Fiduciary income tax: For tax year(s) _______________________________________________________________________________________________XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 58
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61          Personal representative signature (representative must sign to validate authorization)      Date                                                                                             61
62          X                                                                                           99/99/9999/ /                                                                                    62
63          Mail completed application to: Oregon Department of Revenue, PO Box 14110, Salem OR 97309-0910.                                                                                              63
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