(Rev 7/18/07)
32581027
appointment
Apt No
as prescribed for securing proper identification Your social security number is used for identification purposes
As the person claiming the refund for the decedent's estate will you pay out the refund according
best of my knowledge and belief it is true correct and complete
Calendar year or fiscal year beginning (mm/yr) ending (mm/yr)
City or Town State and Zip Code
CLAIMING REFUND
COMPLETE AND ATTACH TO TAX RETURN WHEN FILING
Complete this part only if you checked Box C above
Date of death Social Security number
DEPARTMENT OF REVENUE SC 1310
Did the decedent leave a will?
DUE A DECEASED TAXPAYER
Has a personal representative been appointed by a court for the estate of the decedent?
I request a refund of taxes overpaid by or on behalf of the decedent I declare that I have examined this claim and to the
If "No" a refund cannot be made until you submit a court certificate showing your appointment as personal
If "No" will one be appointed?
If 2 (a) or (b) is answered "Yes" the personal representative must file for the refund
It is mandatory that you provide your social security number on this tax form 42 U S C 405(c)(2)(C)(i) permits a state to
mandates that any person required to make a return to the SC Department of Revenue shall provide identifying numbers
Name of claimant
Name of decedent
No & street (Permanent residence or domicile on the date of death)
Number and street
Part I Check the box that applies to you (Check only one box ) Be sure to sign and date in part III below
Part II
Part III
Person other than A or B claiming refund for the decedent's estate Complete Part II and attach a copy of
Personal representative appointed or certified by a court Attach a court certificate showing your
print
representative or other evidence that you are entitled under state law to receive the refund
Signature and Verification (All filers must complete this part )
Signature of person claiming refund Date
Social Security Privacy Act
STATE OF SOUTH CAROLINA
STATEMENT OF PERSON
Surviving spouse requesting reissuance of a refund check
Tax year decedent was due a refund:
the death certificate or proof of death
to the laws of the state where the decedent was a legal resident?
use an individual's social security number as means of identification in administration of any tax SC Regulation 117 201
YES NO
