Form 804 - Claim For Decedent'S Wisconsin Income Tax Refund Page 2

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2
Form 804
Page
Specific Instructions
Line 3
Check the box on line 3 if you are the surviving parent of
Foreign Address
the deceased. If you check the box on line 3, you must
have proof of death.
If your address is outside the United States or its pos-
sessions or territories, enter the information in the follow-
Line 4
ing order: City, province or state, and county. Follow the
country’s practice for entering the postal code. Do not
Check the box on line 4 if you are the surviving brother or
abbreviate the country name.
sister of the deceased. If you check the box on line 4, you
must have proof of death.
Court Appointed or Certified Personal
Representative
Line 5
Check the box only if you are the decedent’s court-ap-
Check the box on line 5 if you are a creditor of the dece-
pointed personal representative claiming a refund for the
dent. If you check the box on line 5, you must have proof
decedent. You must attach a copy of the domiciliary letter
of death.
showing your appointment.
NOTE:
Line 1
The proof of death is either of the following:
Check the box on line 1 if you are a surviving spouse of
•
The death certificate, or
the deceased and there is no court appointed personal
representative. If you check the box on line 1, you must
•
The formal notification from the appropriate govern-
ment office (for example, Department of Defense)
have proof of death.
informing the next of kin of the decedent’s death.
Line 2
Do not attach the death certificate or other proof of death
Check the box on line 2 if you are a surviving child of the
to Form 804. Instead, keep it for your records and pro-
deceased and there is no court appointed personal repre-
vide it if requested.
sentative. If you check the box on line 2, you must have
proof of death.

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