Form M-Nra - Massachusetts Nonresident Decedent Affidavit (Page 2 of 3) in pdf

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17 Did the decedent ever live in Massachusetts?

Yes

No. If yes, during what period(s)?

_________________________________________________________________________________________________________________________

18 Indicate the address, nature of decedent’s places of residence (e.g., house rented or owned, apartment, hotel or home of relatives or friends) and

lengths of periods outside Massachusetts during the five years preceding death.

_________________________________________________________________________________________________________________________

19 Indicate the address, nature of decedent's places of residence and lengths of periods in Massachusetts during the five years preceding death.

_________________________________________________________________________________________________________________________

10 Where and in what years did the decedent vote or register to vote during the five years preceding death?

_________________________________________________________________________________________________________________________

11 To what state, county or municipality and in what years did the decedent pay a tax on income, real estate, or on intangible property during the last

five years?

_________________________________________________________________________________________________________________________

12 For which taxable year did the decedent last file a Massachusetts income tax return? ________________________________________________

13 In what office(s) of the Internal Revenue Service did the decedent file his federal income tax returns during the five years preceding death? What

was stated therein to be the decedent’s residence?

_________________________________________________________________________________________________________________________

14 What was the decedent’s occupation in the five years preceding death? ___________________________________________________________

Give name and address of employer. If self-employed, indicate same; if in partnership, give the name and address of the firm and the individual

partners. If decedent owned a business, give details.

_________________________________________________________________________________________________________________________

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15 Did the decedent make application for a passport within the last five years?

Yes

No. If yes, give date(s) and place(s) and home address on

application.

_________________________________________________________________________________________________________________________

16 Did the decedent at any time during the five years preceding death execute a will, codicil, trust indenture, deed, mortgage, lease or any other

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document in which decedent was described as a resident of Massachusetts?

Yes

No. If yes, describe such document and state what

residence address(es) were set forth therein.

_________________________________________________________________________________________________________________________

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17 Was the decedent a party to any legal proceeding in Massachusetts during the last five years?

Yes

No. If yes, what was the tribunal, date

and type of action?

_________________________________________________________________________________________________________________________

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18 Did decedent belong to any church, lodge, or other social, fraternal or religious club or organization in Massachusetts?

Yes

No. If yes, give

name, address, positions held, membership status, etc.

_________________________________________________________________________________________________________________________

Form M-Nra - Massachusetts Nonresident Decedent Affidavit Page 2

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