Form Fr-147 - Statement Of Person Claiming Refund Due A Deceased Taxpayer - 2012
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FR-147 Statement of Person
Government of the
2012
*121470110002*
District of Columbia
Claiming Refund Due
a Deceased Taxpayer
OFFICIAL USE ONLY
Vendor ID# 0002
This is a FILL-IN format. Please do not handwrite any data on this form other than your signature.
Personal information
Deceased’s First name
Last name
M.I.
Deceased’s social security number
Date of death (MM/DD/YY)
Your First name
Last name
M.I.
Your home address (number and street)
City
State
Zip code +4
Statement of Claimant
Your relationship to the deceased
Spouse/domestic partner
Administrator
Executor
Fill in only one:
Other
4
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 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 2012 DC income tax?
Name
Claimant’s SSN
Relationship to deceased
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.
2012 FR-147
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Statement of Person Claiming Refund Due a Deceased Taxpayer
Revised 03/2012
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