Form Rev-1313 - Application For Refund Of Pennsylvania Inheritance/estate Tax
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1REV-1313 (Ex) 05-17
APPLICATION FOR REFUND
OF PENNSYLVANIA
BuREAu of INDIVIDuAL TAxES
INHERITANCE/ESTATE TAX
Po Box 280601
HARRISBuRg PA 17128-0601
INSTRUCTIONS
Complete all requested information and mail to: PA DEPARTMENT of REVENuE, BuREAu of INDIVIDuAL TAxES,
Po Box 280601, HARRISBuRg, PA, 17128-0601. See additional instructions on the reverse side.
DECEDENT INFORMATION
Decedent Name
file Number
Date of Death
Social Security Number
START
MM/DD/YYYY
REFUND INFORMATION
Amount Requested: $
Requesting a refund on: (check only one box)
original or Supplemental Probate Return
Remainder Return
Estate Tax
Transferee Return – Provide ACN
Joint/Transfer on Death Asset – Provide ACN
List Receipt Number(s) of all payments made for the Return Type or ACN for which you are requesting a refund.
RECEIPT NuMBER
PAYMENT AMouNT
RECEIPT NuMBER
PAYMENT AMouNT
If additional space is needed, attach on a separate sheet of paper.
EXPLANATION OF OVERPAYMENT
If additional space is needed, attach on a separate sheet of paper.
REQUESTOR INFORMATION
Name
Phone Number
Email Address (optional)
Street
City
State
ZIP Code
By signing below, I declare under penalty of law that the information provided is true and correct; and that the refund being
requested was paid by me or a party legally represented by me.
Please sign after printing. The Department does not accept electronic signatures.
Requestor Signature
Date
MM/DD/YYYY
Please allow six to eight weeks for the processing of your refund request.
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