Form Et-95 - Claim For Refund Of New York State Estate Tax


New York State Department of Taxation and Finance
Claim for Refund of New York State Estate Tax
Decedent’s last name
First name
Middle initial
Social security number ( SSN )
Date of death
Employer identification number ( EIN ) of estate
Executor — If there has been a change of executor and you are submitting Letters Testamentary or Letters of Administration with this form,
indicate in this box the type of letters. Enter L if regular, LL if limited letters. If you are not submitting letters with this form, enter N ..............................
Attorney’s or authorized representative’s last name
First name
Executor’s last name
First name
If more than one executor, mark an X E-mail address of executor
In care of
( firm’s name )
Mark an X
if POA is
in the box
( see instructions )
Address of attorney or authorized representative
Address of executor
ZIP code
ZIP code
PTIN or SSN of attorney or authorized rep.
Telephone number
Social security number of executor
Telephone number
1. Are you requesting a refund?
( see instructions )
Yes: Continue with line 2.
No: Complete lines 7 and 8.
2. Are you protesting either a denied or reduced refund, or a previously-paid bill?
Yes: Complete lines 3, 4, 5, and 8.
No: Do not file this form. Go to line 6.
3. Enter the amount of refund claimed.
4. Enter the amount of total estate tax paid.
5. If protesting a paid bill, enter the assessment ID.
6. Do you want to request a refund as the result of a federal audit change?
Yes: File Form ET-115 or Form ET-115.1.
No: For all other refund claims, file an amended
Form ET-706 or Form ET-90.
7. You may file this form as a protective claim (see instructions on back) to preserve your rights to a possible refund when there is an
unresolved issue, and the statute of limitations is due to expire before the matter is settled.
8. Attach a detailed explanation of all facts and figures on which you base your refund or protective claim.
If an attorney or authorized representative is listed above, he or she must complete the following declaration.
I declare that I have agreed to represent the executor(s) for the above estate, that I am authorized to receive tax information regarding the
estate, and I am
an attorney
a certified public accountant
an enrolled agent
( mark an X in all that apply ):
a public accountant enrolled with the New York State Education Department
Signature of attorney or authorized representative
E-mail address of attorney or authorized representative
Certification. I certify that this claim and any attachments are to the best of my knowledge and belief true, correct, and complete.
Signature of executor
Signature of co-executor
Print firm name if preparer other than executor
Signature of individual preparing this document other than executor
(or yours if self-employed)
Address of preparer
ZIP code
E-mail address of individual preparing document
Preparer’s PTIN or SSN
Preparer’s NYTPRIN


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