rom 1810 Statement of Person Claiming OMB No. 1545-0073
(Rev. August 1984) Refund Due a Deceased Taxpayer Expires 6-30-87

Department of the Treasut . c
internal Revenue Service > For Paperwork Reduction Act Notice, see instructions on back of form.

Tax year decedent was due a refund
Calendar year or other tax year beginning 19 , and ending ,19

Name of decedent Date of death ‘Social security number of decedent

Name of person claiming rafund

Address (number and street)

Please type or print

City or town, State, and ZIP code

Tam filing this statement as (check only one box):

A (J Surwving spouse, claiming a refund based on a joint return. (See Death of Taxpayer in Instructions for Form 1040.)
B () Decedent's personal representative.’ Attach a court certificate showing your appointment

Cc ( Person, other than A or B, claiming refund for the decedent's estate. Complete Schedule A and attach a copy of the death
certificate or proof of death.”
Please attach requested information and sign below. If you checked Box C, also complete Schedule A

SY (To be completed only if you checked Box C above.) Yes| No

1 _Did the decedent leave a will? woe ee? coe
2 a Hasa personal representative been appointed for the estate of the decedent?

b If "No," will one be appointed? Co
If 2a or bis answered ‘'Yes,”’ do not file this form. The personal representative should file for the refund.
3 As the person claiming the refund for the decedent's estate, will you pay out the refund according to the laws of the State Yf;

where the decedent was a legal resident? . a . Pe oo
If "No," a refund cannot be made until you submit a court certificate showing your appointment as personal representative or other
evidence that you are entitled, under State law, to receive the refund.

Signature and Verification

Trequest a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, | declare that | have examined this claim and to the best of my knowledge and
belief, itis true, correct, and complete.

Signature of person claiming refund > Date >

For purposes of this form, personal representative means the executor, executrix, administrator, or administratrx of the decedent's estate; if no executor, executrix,
administrator, or administratrix is appointed, qualified and acting within the United States, personal representative means any person in actual or constructive possession of any
property of the decedent,

May be the original or an authentic copy of a telegram or letter from the Department of Defense notifying the next of kin of the decedent’s death while in active service, or a
death certificate issued by the Department of Defense.

Form 1310 (Rev.8-84)


Instructions

Paperwork Reduction Act Notice

We ask for this information to carry out the Internal
Revenue laws of the United States. We need it to ensure
that taxpayers are complying with these laws and to allow
us to figure and collect the right amount of tax. You are
required to give us this information.

Who Must File

File Form 1310 if you are claiming a refund on behalf of a
taxpayer who has died. Attach Form 1310 to the return of
the taxpayer who has died. However, if you are a surviving
spouse filing a joint return with the decedent, you do not
have to file Form 1310.

‘U.S. GOVERNMENT PRINTING OFFICE: 1985 - 544-104/25041(5-06349>