Form Et-95 - New York Claim For Refund Of New York State Estate Tax
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ET-95
New York State Department of Taxation and Finance
Claim for Refund of New York State Estate Tax
(9/14)
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
MI
Executor’s last name
First name
MI
In care of
If more than one executor, mark an X E-mail address of executor
( firm’s name )
Mark an X
if POA is
in the box
( see instructions )
attached
Address of attorney or authorized representative
Address of executor
City
State
ZIP code
City
State
ZIP code
PTIN or SSN of attorney or authorized rep.
Telephone number
Social security number of executor
Telephone number
(
)
(
)
Note: Do not file this form to claim a refund that is a result of a federal audit change; you must file an amended Form ET-90 or Form ET-706,
applicable to the specific date of death
.
(see instructions)
1. Are you requesting a refund?
(Your answer should be No to this question if you are filing a protective claim; see instructions )
Yes: Continue with line 2.
No: Complete lines 6 and 7.
2. Are you protesting either a denied or reduced refund, or a previously-paid bill?
Yes: Complete lines 3, 4, 5, and 7.
No: Do not file this form. File an amended Form ET-90
or Form ET-706.
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.
L-
6. 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.
7. 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
Date
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
Date
Signature of co-executor
Date
Print firm name if preparer other than executor
EIN
Signature of individual preparing this document other than executor
Date
(or yours if self-employed)
Address of preparer
City
State
ZIP code
E-mail address of individual preparing document
Preparer’s PTIN or SSN
Preparer’s NYTPRIN
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