(2) A written notice and request under this section must:
(a) Include the name, last known address and Social Security number of the deceased individual;
(b) State the date of the deceased individual’s death;
(c) State that the deceased individual received public assistance or medical assistance that was subject to a claim for reimbursement under ORS 411.640, 411.708, 411.795 or 416.350; and
(d) Request that the financial institution provide all or any part of the following information to the department or the authority:
(A) Whether the financial institution held on the date of the deceased individual’s death any deposit account in the deceased individual’s name or in more than one name, one of which is the deceased individual’s name;
(B) The balance on deposit in each deposit account described in subparagraph (A) of this paragraph on the date of the deceased individual’s death;
(C) The name of each person to whom the financial institution disbursed funds from a deposit account described in subparagraph (A) of this paragraph on or after the date of the deceased individual’s death, if the financial institution closed the deposit account on or after the date of the deceased individual’s death;
(D) A record of the activity in each of the deposit accounts described in subparagraph (A) of this paragraph in the period that begins 30 days before the date of the deceased individual’s death and ends on the date of the deceased individual’s death;
(E) A copy of any affidavit or declaration the financial institution received under ORS 708A.430 or 723.466; and
(F) The name and address of any person named as an owner of a deposit account described in subparagraph (A) of this paragraph, if the financial institution has the information in the financial institution’s records.
(3) The department or the authority may submit an affidavit or declaration under ORS 708A.430 or 723.466 at the same time the department or authority submits a notice and request under subsection (2) of this section.
(4) The department and the authority shall reimburse a financial institution as provided in ORS 192.602 for all reasonable costs and expenses the financial institution incurs to provide information in response to a notice and request under subsection (2) of this section. [2015 c.129 §2; 2017 c.51 §3]
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