Schedule F - Statement Of Claimant To Refund Due Deceased Taxpayer

SCHEDULE F

YEAR

STATEMENT OF CLAIMANT TO REFUND DUE DECEASED TAXPAYER

Attach completed schedule to decedent's return

NAME(S) SHOWN ON RETURN

YOUR SOCIAL SECURITY NUMBER

NAME OF DECEDENT

NAME OF CLAIMANT

TYPE

DATE OF DEATH

SOCIAL SECURITY NUMBER

SOCIAL SECURITY NUMBER

OR

NUMBER AND STREET

NUMBER AND STREET

(permanent residence or domicile at date of death)

PRINT

CITY, STATE AND ZIP CODE

CITY, STATE AND ZIP CODE

I am filing this statement as (check only one box):

ATTACH A LIST TO THIS

SCHEDULE CONTAINING THE

A.

Surviving wife or husband, claiming a refund based on a joint return.

NAME AND ADDRESS OF THE

SURVIVING SPOUSE AND

B.

Administrator or executor. Attach a court certificate showing your appointment.

CHILDREN OF THE DECEDENT

C.

Claimant for the estate of the decedent, other than above. Complete the rest of this schedule and

attach a copy of the death certificate or proof of death.*

TO BE COMPLETED ONLY IF BOX C ABOVE IS CHECKED

YES

NO

1.

Did the decedent leave a will? .............................................................................................................................................................

2(a).

Has an administrator or executor been appointed for the estate of the decedent? ...............................................................................

2(b).

If "NO" will one be appointed? ............................................................................................................................................................

If 2(a) or 2(b) is checked "YES", do not file this form. The administrator or executor should file for the refund.

3.

Will you, as the claimant for the estate of the decedent, disburse the refund according to the laws of the state in which the decedent

was domiciled or maintained a permanent residence? ........................................................................................................................

If "NO", payment of this claim will be withheld pending submission of proof of your appointment as administrator or

executor or other evidence showing that you are authorized under state law to receive payment.

SIGNATURE AND VERIFICATION

I hereby make request for refund of taxes overpaid by, or on behalf of the decedent and declare under penalties of perjury, that I have examined

this claim and to the best of my knowledge and belief, it is true, correct and complete.

Signature of claimant

Date

*

May be the original or an authentic copy of a telegram or letter from the Department of Defense notifying the next of kin of death while in

active service, or a death certificate issued by the appropriate officer of the Department of Defense.