Arizona Form 131 - Claim For Refund On Behalf Of Deceased Taxpayer - 2015
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1FOR
Arizona Form
CALENDAR YEAR
Claim for Refund on Behalf of Deceased Taxpayer
131
2015
Please print or type.
MONTH YEAR
For calendar year decedent was due a refund:
2
0
1
5
OR
Fiscal year ending:
M
M
Y
Y
66
1 Decedent’s Name (last, first, middle initial)
2 Date of Death
3 Decedent’s Social Security Number
M M D D Y Y Y Y
4 Name of Person Claiming Refund (last, first, middle initial)
5 Claimant’s Social Security or Federal I.D. No.
Apt. No.
REVENUE USE ONLY. DO NOT MARK IN THIS AREA.
6 Home Address of Person Claiming Refund - number and street, rural route
88
State
ZIP Code
7 City, Town or Post Office
8 Claimant’s Relationship to Decedent
81 PM
80 RCVD
Check the box that applies to you. Check only one box.
Part 1
Be sure to complete Part 3 below.
9a
Surviving spouse claiming a refund based on a joint return.
9b
Court-appointed or certified personal representative.
Include a court certificate (issued after death) showing your appointment.
9c
Person other than 9a or 9b claiming refund for the decedent’s estate.
See instructions and complete Part 2 below.
Part 2
Complete Part 2 only if you checked box 9c in Part 1 above.
YES
NO
10a Did the decedent leave a will? ......................................................................................................
10a
10b Has a personal representative been appointed for the estate of the decedent? ..........................
10b
10c If you answered “No” on line 10b, will one be appointed? ............................................................
10c
If you answered “Yes” to 10a or 10b, do not file this form. The personal representative must
file for the refund.
11
As the person claiming the refund for the decedent’s estate, will you pay out the refund
according to the laws of the state where the decedent was a legal resident? ..............................
11
If you answered “No” on line 11, a refund cannot be made until you submit a court certificate
showing your appointment as personal representative or until you submit other evidence that
you are entitled under state law to receive the refund.
Part 3
I request a refund of taxes overpaid by, or on behalf of, the decedent. Under penalties of perjury, I declare that the statements
made on this form have been examined by me and to the best of my knowledge, they are true, correct and complete.
Signature of Person Claiming Refund
Date
Print Form
ADOR 10412 (15)
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