District of Columbia Nonresident Request for Refund

Nonresident Request for Refund
Form D-40B
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STAPLE OTHER REQUESTED DOCUMENTS IN UPPER LEFT BEHIND THIS FORM	

Government of the
District of Columbia

Nonresident
	
2023 D-40B
Request for Refund

*230401110002*

Important: Print in CAPITAL letters using black ink. Leave lines blank that do not apply.

Personal information	

OFFICIAL USE ONLY

Your first name 	

Your Taxpayer Identification Number (TIN)	

M.I.	

Vendor ID#0002

Last name

Your date of birth (MMDDYYYY)	

Daytime phone number	

Current mailing address (number, street and suite/apartment number if applicable)	

City	

State	

Zip Code + 4

Country or U.S. commonwealth/U.S. territory

Email Address

STAPLE W-2s AND OTHER WITHHOLDING STATEMENTS HERE

Review categories A - B below and attach your withholding statements and, if applicable, DD Form 2058, JAN 2018. Indicate
the state in the boxes below. Please select only one between A and B. Provide property information on Line C if applicable.
A. Commuter/Domiciliary State Exemption: I declare that during the taxable year shown above I either commuted on a daily basis
from my place of residence to work in the District of Columbia (DC) or I was a domiciliary or legal resident of the state listed
and my only income from sources within DC was from wages and salaries, which are subject to taxation by (enter the 2 letter
state abbreviation for your domiciliary or legal state of residency). I did not maintain a place of abode in DC for a total of 183
days or more. (see instructions). DC tax was erroneously withheld from salary and wages paid to me by my employer.
B. Military spouse exemption: If your non-resident military spouse was in the armed services during 2023, and you are not a DC
resident or elected to use the same residence as your non-resident military spouse, enter the state of domicile declared on DD
Form 2058. You must complete and attach a copy of DD Form 2058, JAN 2018 with the D-40B.
C. List the type and location of any DC real property you own. Type of property
Address #1 (number, street and suite/apartment number if applicable)

Address #2 (number, street and suite/apartment number if applicable)

Refund request

Round cents to nearest dollar. If amount is zero, leave line blank.

1.

DC income tax withheld Attach copies of your withholding statements.

1

2.

2023 DC estimated income tax payments

2
3

3. Refund request Add Lines 1 and 2.
Will the refund go to an account outside the US?

Yes

No

$	
$	
$	

.00
.00
.00

See instructions.

	 Refund Options: For information on the tax refund card and program limitations, see instructions or visit our website MyTax.DC.gov
	 Mark one refund choice:	
Direct Deposit or 	
ReliaCard (see instructions) or 	
Paper Check

Direct Deposit If you want your refund deposited in your bank account, fill in type of account

checking

savings and enter the routing number and account

number below.

Routing Number	
Fill in

Account Number

if you agree to receive your 1099-G Income Tax Refund Statement electronically (see instructions).

Third party designee To authorize another person to discuss this return with OTR, fill in here
Designee’s name	

Signature

and enter the name and phone number of that person. See instructions.
Phone number

Under penalties of law, I declare that I have examined this request and any attached statements and, to the best of my knowledge, they are correct.

Your signature 	

Date 	

Preparer’s signature
Preparer’s Tax Identification Number (PTIN)

Revised 08/2023

Who must file a Form D-40B?

Any non-resident of DC claiming a refund of DC income tax withheld or paid by estimated tax payments must file a D-40B. A
non-resident is anyone whose permanent home was outside
DC during all of 2023 and who did not maintain a place of
abode in DC for a total of 183 days or more during 2023.
• A joint request for refund is not permitted.
• Attach all W2/1099 showing DC withholding to the front of
this form. Schedule K-1's are not a substitute for W2/1099.
• Attach your DD Form 2058, JAN 2018 if completing
Category B.
• Be sure to include your date of birth on the front page.
NOTE: If you moved into DC with the intent of becoming a domiciliary, you are considered a DC resident and the 183 days does
not apply.
NOTE: If you are claiming a military spouse exemption, a copy
of DD Form 2058, JAN 2018 must be completed and attached
to your D-40B request.

Taxpayer Identification Number (TIN)
You must have a Taxpayer Identification Number (TIN),
whether it is a Federal Employer Identification Number
(FEIN), Social Security Number (SSN) or Individual
Taxpayer Identification Number (ITIN).
• An FEIN is a number issued by the Internal Revenue Service
(IRS). To apply for an FEIN, get Form SS-4, Application for
Employer Identification Number, or get this form online at
www.irs.gov/businesses and click on Employer Identification
Number (EIN) under Starting a Business. You may also get
this form by calling 1-800-TAX-FORM (1-800-829-3676).
• An SSN is a valid number issued by the Social Security
Administration (SSA) of the United States Government. To
apply for an SSN , get form SS-5, Application for a Social
Security Card, from your local SSA office or get this form
online at www.ssa.gov. You may also get this form by calling
1-800-772-1213.
• An ITIN, Individual Taxpayer Identification Number is a valid
number issued by the IRS. The IRS issues ITINs to
individuals who are required to have a U.S. taxpayer
identification number but who do not have, and are not
eligible to obtain, a Social Security number (SSN) from the
Social Security Administration (SSA). ITINs do not serve any
purpose other than federal tax reporting.

Preparer Tax Identification Number (PTIN)
•

PTIN, Preparer Tax Identification Number is an
identification number issued by the IRS. All paid tax
preparers must use their PTIN on tax returns or claims for
refund.

Revised 08/2023

Where to send a Form D-40B?

You must mail the completed Form D-40B and attachments to:
Office of Tax and Revenue
PO Box 96147
Washington, DC 20090-6147

How will we respond to your request?

• We will send you a refund for the amount you request if we
determine you were not a resident of DC during 2023; or
• Based on the information you provide, we may determine that you
qualify as a DC resident. If so, we will require that you file a
DC Form D-40 tax return.
• Missing attachments or supporting documentation or if your form is
incomplete, will cause delays in processing.
Notice: In order to comply with banking rules, we will not issue a
refund to or through a foreign financial institution. Instead, we
will issue a paper check. In the event of a rejection of direct deposit,
refunds will be re-issued on a paper check.
Reminders
U.S. Bank ReliaCard™
If you want your refund on a ReliaCard, select “ReliaCard” under the
Refund Options on the D-40B form. Refunds under $2 or greater than
$4,000 do not qualify for the ReliaCard. Non-qualified refunds will receive a paper check if direct deposit is not selected.
Pre-Acquisition Disclosures
The Consumer Financial Protection Board (CFPB) has published its final Prepaid Account Rule, creating detailed consumer protections for
prepaid accounts. For tax year 2023, if you elect to receive a
refund using the U.S. Bank ReliaCard™ or use a pre-paid card to
make payments, you are required to review and acknowledge the PreAcquisition Disclosures (Short and Long Forms) prior to selecting
the ReliaCard option as method for receiving a refund or using a
prepaid card when making a payment.
Electronic 1099-G
The Office of Tax and Revenue (OTR is offering a paperless option
for receiving the Form 1099-G income tax refund statement. You
will receive a paper statement unless you choose the paperless
option.