Form 150-101-152 - Application For Discharge From Personal Liability For Tax On A Decedent'S Income

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APPLICATION FOR DISCHARGE FROM PERSONAL
FOR OFFICE USE ONLY
Date Received
LIABILITY FOR TAX ON A DECEDENT’S INCOME
*
Probate No. (if probated)
County
Federal Identification Number
*
Decedent’s Name
Date of Death
Social Security Number
*
Spouse’s Name
Date of Death (if spouse is deceased)
Spouse’s Social Security Number
Decedent’s Last Permanent Address
Representative’s Telephone Number
Representative’s Name
Representative’s Current Address
*
Social Security and federal identification numbers are required for identification purposes. OAR 150-305.100.
I hereby apply for a discharge from personal liability for tax on income of the above named decedent as provided by
ORS 316.387. I certify that I represent the decedent in a fiduciary capacity as personal representative, administrator,
trustee, or other fiduciary as indicated by my title below. I have attached a copy of the document showing my appoint-
ment.
I understand that this discharge becomes effective 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 nine months after receipt of this application by
the Oregon Department of Revenue and during which no notification of tax liability is made.
I understand that a discharge under ORS 316.387 does not discharge me from liability to the extent that assets of the
decedent’s estate are still in my possession or control.
Discharge from personal liability is requested for the following tax returns:
For tax year(s) ____________________________________________
I hereby authorize the following attorney(s) or individual(s) to represent me and to receive all confidential tax informa-
tion relating to the decedent and the estate.
Accountant(s) or Tax Preparer(s)
Attorney(s)
Telephone Number
Telephone Number
Mail all correspondence to:
Representative
Attorney
Accountant or Tax Preparer
X
Signature of Representative
Date
(representative must sign to validate authorization)
Representative’s Title
150-101-152 (3-96)
Mail to: Oregon Department of Revenue
PO Box 14110
Salem OR 97309-0910

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