Form Fr-147 - Statement Of Person Claiming Refund Due A Deceased Taxpayer
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*061470110000*
FR-147 Statement of Person
Government of the
2006
District of Columbia
Claiming Refund Due a
Deceased Taxpayer
Important:
Print in CAPITAL letters using black ink.
Personal information
Deceased’s name - First name
Last name
M.I.
Deceased’s social security number
Date of death (MM/DD/YY)
Your name - First name
Last name
M.I.
Your home address (number and street)
Apartment number
City
State
Zip code +4
Statement of Claimant
Your relationship to the deceased
Spouse
Administrator
Executor
Fill in only one:
Other
Specify
Yes
No
Did the deceased leave a will?
Yes
No
Has an executor or administrator been appointed for the estate?
Yes
No
If no, will one be appointed?
Yes
No
Will you pay out the refund to beneficiaries according to the laws of the state where the deceased was a legal resident?
If no, a refund cannot be made until you submit a court certificate showing your appointment as a personal representative
or other evidence that you are entitled, under DC law, to receive the refund.
If other than the deceased, who paid deceased’s 2006 DC income tax?
Name
Relationship
Signature
I request a refund of DC income tax overpaid by or on behalf of the deceased. Under penalties of law, I declare that
I have examined this claim and, to the best of my knowledge, it is correct.
Your signature
Date
Attach this form to the deceased’s D-40 along with a copy of the death certificate or other proof of death.
If you are filing as an administrator or executor, attach a copy of the court certificate of appointment.
2006 FR-147
Statement of Person Claiming Refund Due a Deceased Taxpayer
Revised 9/06
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Parent category: Financial