rom 1310 Statement of Person Claiming
Se eaernt the Trossury Refund Due a Deceased Taxpayer

Internal Revenue Service
Tax year decedent was due a refund:

OMB No. 1545-0073
Expires 6-30-87

Calendar year or other tax year beginning .19 , and ending ,19
Name of decedent Date of death ‘Social security number of decedent

z

& | Name of person claiming refund

z

2 Address (number and street)

$

&

© | City or town, state, and ZIP code

| am filing this statement as (check only one box):

A (Surviving spouse, claiming a refund based on a joint return. (See Death of Taxpayer in instructions for Form 1040 or Form 1040A.)

B (1 Decedent's court appointed personal representative. Attach a court certificate showing your appointment. (See instructions on back
of form.)

C C 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. (See instructions on back of form.)

Please attach requested information and sign below. If you checked Box C, also complete Schedule A.

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

1__Did the decedent leave a will?

2 a_Hasa personal representative been appointed b by a court for the estate of the decedent?
b_ If "No," will one be appointed? .
If 2a or 2b is 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 Mh
where the decedent was a legal resident?

If “No,” a refund cannot be made until you submit a court certificate showing your appointment as 5 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 Paperwork Reduction Act Notice, see instructions on back of form. Form 1310 (Rev. 9-85)


Form 1310 (Rev. 9-85)

Page 2

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.

Purpose of Form.—Form 1310 is used to claim a refund
on behalf of a taxpayer who has died.

Who Must File. —If you are claiming a refund on behalf of
a taxpayer who has died, complete Form 1310 and attach it
to the decedent's tax return. However, if you are a surviving
spouse filing a joint return with your deceased spouse, you
do not have to file Form 1310. See Death of Taxpayer in
the instructions for Form 1040 or Form 1040A.

Box B.—Check Box B only if you are the decedent's court
appointed personal representative. For purposes of this
form, personal representative means the executor,
executrix, administrator, or administratrix of the decedent's
estate, as certified or appointed by the court.

You must attach a court certificate showing your
appointment. A copy of the decedent's will will not be
accepted as evidence that you are the decedent's court
appointed personal representative.

Box C.—Check Box C if you are not a surviving spouse
claiming a refund based on a joint return, or you have not
been appointed by the court as the decedent's persona!
representative. For example, check Box C if you area
surviving spouse claiming a refund on behalf of your
deceased spouse's separate tax return and there is no
court appointed personal representative.

If you check Box C, you must complete Schedule A of
Form 1310. You must also attach a copy of the death
certificate or proof of death. The proof of death may be the
origina! 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.

U.S. GOVERNMENT PRINTING OFFICE: 1986-493-302 E.1. 43-0787287