RPD - 41083
Rev. 01/06/2012
STATE OF NEW MEXICO - TAXATION & REVENUE DEPARTMENT
AFFIDAVIT TO OBTAIN REFUND
OF NEW MEXICO TAX DUE A DECEASED TAXPAYER
Purpose of Form. Form RPD-41083 is to be used to claim a refund of New Mexico tax on behalf of a deceased taxpayer.
Who Must File. If you are a court-appointed or certified personal representative, you must include Form RPD-41083 with the taxpayer's refund
claim (New Mexico income tax return). Complete Part 1: Affidavit for Personal Representative, and sign the affidavit. Notary is not required.
If you are not a surviving spouse, and no personal representative has been appointed, you must include Form RPD-41083 with the taxpayer's
refund claim (New Mexico income tax return). Complete Part 2: Affidavit for Successor, and sign and notarize the affidavit.
Tax year decedent was due a refund:
Calendar year_________ or other tax year beginning ________________________ and ending ____________________
Name of decedent
Decedent's social security number
Date of death
Claimant's social security number
Name of person claiming refund
Claimant's contact number
Claimant's mailing address
City
State
ZIP code
Part 1: Affidavit for Personal Representative
____________________________________________, the affiant herein, having been duly sworn, states upon oath:
1.
That he or she has been appointed by a court as the personal representative for the estate of the decedent.
2.
That a copy of that court appointment is attached.
3.
That a copy of the death certificate or proof of death is attached. (An original or an authentic copy of a telegram or letter from the
Department of Defense notifying the next of kin of the decedent's death will constitute proof of death.)
4.
That a refund claim (New Mexico income tax return) on behalf of the decedent is attached.
Part 2. Affidavit for Successor.
_____________________________________________, the affiant here in, having been duly sworn, states upon oath:
1.
That he or she is the successor of _________________________________________, deceased.
2.
That the value of the entire probate estate of the decedent, wherever located, less liens and encumbrances, does not exceed
$50,000.
3.
That thirty (30) days have elapsed since the death of the decedent.
4.
That the affiant, as successor of the decedent, is entitled to the payment of any sums of money due and owing to the decedent.
5.
That a copy of the death certificate or proof of death is attached. (An original or an authentic copy of a telegram or letter from the
Department of Defense notifying the next of kin of the decedent's death while in active service will constitute proof of death.)
6.
That a refund claim (New Mexico income tax return) on behalf of the decedent is attached.
I request a refund of taxes overpaid by or on behalf of the decedent. Under penalty of perjury, I declare that I have examined
this claim and to the best of my knowledge and belief, it is true, correct and complete.
Signature of person claiming refund _________________________________________ Date _____________
Subscribed and sworn before me this ___________ day of _______________________________, 20________
Notary Public ___________________________________________
My Commission Expires ______________