Form 480.80 - Fiduciary Income Tax Return (Estate Or Trust)

Form 480.80 Rev. May 3 13

20__

COMMONWEALTH OF PUERTO RICO

Serial Number

Reviewer:

Liquidator:

DEPARTMENT OF THE TREASURY

Field Audited by:

FIDUCIARY INCOME TAX RETURN

(ESTATE OR TRUST)

AMENDED RETURN

Date ___/ ___/ ___

Receipt Stamp

FOR THE CALENDAR YEAR 20___ OR TAXABLE YEAR

M N

BEGINNING ON___________, 20____ AND ENDING ON ___________, 20____

Employer Identification Number

Estate or Trust Name

Industrial Code

Municipal Code

Postal Address

Telephone Number - Extension

Municipality

Country

Zip Code

Date created

Location of Principal Industry or Business (Number, Street, City)

Day_____ Month_____ Year _____

Place created

Fill in the corresponding oval, if applicable:

CHANGE OF ADDRESS:

Yes

First Return

Last Return

Type of taxpayer:

Estate

Trust

Fill in here if the estate or trust corresponds to a resident individual investor

If the taxpayer is an estate, indicate:

1. Date of death of decedent ________________________________

2. Social security number _____________________________________

Indicate accounting method used:

Cash

Accrual

Other _____________________________________________________

If the gross income of the estate or trust was $5,000 or more, include with this return a copy of the will or trust’s deed.

Indicate the name and address:

a) Fiduciary: ___________________________________________________________________________________________________________________________

b) Trustee: _____________________________________________________________________________________________________________________________

GO TO PAGE 2 TO DETERMINE YOUR REFUND OR PAYMENT.

AMOUNT OVERPAID (Part II, line 12. Indicate distribution on lines A, B and C) ..................................................................................

(1)

A) Contribution to the San Juan Bay Estuary Special Fund .............................................................................................................

(1A)

B) Contribution to the Special Fund for the University of Puerto Rico ................................................................................................

(1B)

C) TO BE REFUNDED .............................................................................................................................................................

(1C)

AMOUNT OF TAX DUE (Part II, line 12) .......................................................................................................................................

(2)

(a)

(3a)

Less: Amount paid

Income Tax .............................................................................................................................................

(b)

Interest .....................................................................................................................

(3b)

(c)

Surcharges ________________ and Penalties _________________ .................................

(3c)

BALANCE OF TAX DUE (Subtract line 3(a) from line 2)) ................................................................................................................

(4)

OATH

I hereby declare under penalty of perjury that this return, including all schedules and other documents attached to it, has been examined by me and it is true,

correct and complete. The declaration of the person that prepares this return (except the taxpayer) is based on the information available, and this information

has been verified.

Fiduciary or Agent’s Name

Fiduciary or Agent’s Signature

Date

Specialist’s Name (Print)

Name of Firm or Business

Registration Number

Specialist's Signature

Date

Self-employed Specialist

(fill in here)

NOTE TO TAXPAYER: Indicate if you made payments for the preparation of your return: