Form FR-147 Fillable 2013 Statement of Person Claiming Refund Due a Deceased Taxpayer
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(: 0) Unchecked (: executor) Unchecked (: other) Unchecked (: spouse) Unchecked (address line 2) (City) (Claimant s SSN) (Clear form for processing next client) Clear (Date of death (MM/DD/YY) (Deceased s First name) (Deceased s social security number) (Did the deceased leave a will: No) Unchecked (Did the deceased leave a will: Yes) Unchecked (Has an executor or administrator been appointed for the estate: No 2) Unchecked (Has an executor or administrator been appointed for the estate: Yes 2) Unchecked (If no will one be appointed: No 3) Unchecked (If no will one be appointed: Yes 3) Unchecked (Last name) (M I) (Name) (Print form for processing) Print (Relationship to deceased) (Spouse/domestic partner) (State) (text) (Will you pay out the refund to beneficiaries according to the laws of the state where the deceased was a legal resident: No 4) Unchecked (Will you pay out the refund to beneficiaries according to the laws of the state where the deceased was a legal resident: Yes 4) Unchecked (Your First name) (Your home address (number and street) (Zip code ) (zip plus 4) 2012 FR 147 a Deceased Taxpayer *121470110002* Administrator Attach this form to the deceased s D 40 along with a copy of the death certificate or other proof of death City State Zip code +4 Claiming Refund Due Deceased s First name M I Last name Deceased s social security number Date of death (MM/DD/YY) Did the deceased leave a will? District of Columbia Executor Fill in only one: FR 147 Statement of Person l Government of the Has an executor or administrator been appointed for the estate? I have examined this claim and to the best of my knowledge it is correct If no a refund cannot be made until you submit a court certificate showing your appointment as personal representative If no will one be appointed? Yes No If other than the deceased who paid deceased s 2012 DC income tax? If you are filing as an administrator or executor attach a copy of the court certificate of appointment Name Claimant s SSN OFFICIAL USE ONLY or other evidence that you are entitled under DC law to receive the refund Other 4Specify Personal information Relationship to deceased Revised 03/2012 Signature I request a refund of DC income tax overpaid by or on behalf of the deceased Under penalties of law I declare that Spouse/domestic partner Statement of Claimant Statement of Person Claiming Refund Due a Deceased Taxpayer This is a FILL IN format Please do not handwrite any data on this form other than your signature Vendor ID# 0002 Will you pay out the refund to beneficiaries according to the laws of the state where the deceased was a legal resident? Your First name M I Last name Your home address (number and street) Your relationship to the deceased Your signature Date