Delaware Form 209 - Claim For Refund Due On Behalf Of Deceased Taxpayer - 2012

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DELAWARE
FORM 209
TAX YEAR
Reset
2012
Print Form
CLAIM FOR REFUND DUE
ON BEHALF OF DECEASED TAXPAYER
DECEDENT’S NAME
DATE OF DEATH
DECEDENT’S SOCIAL SECURITY NUMBER
CLAIMANT’S NAME
CLAIMANT’S SOCIAL SECURITY NUMBER
CLAIMANT’S ADDRESS
CITY
STATE
ZIP CODE
PART 1
CHECK THE BOX THAT APPLIES TO YOU (CHECK ONLY ONE BOX). MAKE SURE TO SIGN AND DATE IN PART 3 BELOW
A.
Personal representative appointed or certified by court. You MUST attach a court certificate showing your appointment.
B.
Person, other than A, claiming refund for the decedent’s estate. Complete Part 2 and attach a copy of the death certificate or proof of death.
PART 2
COMPLETE THIS PART ONLY IF YOU CHECKED BOX B ABOVE
YES
NO
1.
Did the decedent leave a will?...................................................................................................................................................
2a.
Has a personal representative been appointed by a court for the estate of the decedent?.............................................
2b.
If “NO”, will one be appointed?...................................................................................................................................................
If 2a or 2b is answered “YES”, the personal representative must file for the refund
As the person claiming the refund for the decedent’s estate, will you pay out the refund according to the
3.
laws of the state where the decedent was a legal resident?................................................................................................
If 3 is answered “No”, a refund cannot be made until you submit a court certificate
showing your appointment as personal representative or other evidence that you
are entitled, under state law, to receive the refund.
PART 3
SIGNATURE AND VERIFICATION (ALL FILERS MUST COMPLETE THIS PART)
I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties 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.
Claimant’s Signature
Date
*DF21512019999*
(REVISED 12/07/12)

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