Massachusetts Statement of Claimant to Refund Due a Deceased Taxpayer

Statement of Claimant to Refund Due a Deceased Taxpayer
form M-1310
Massachusetts Department of Revenue

Form M-1310
Statement of Person Claiming Refund Due a Deceased Taxpayer
Please print or type. Calendar year of the refund due
Name of decedent

Social Security number

Date of death

3

3

3

Street address of decedent
City/Town

State

Zip

Name of claimant

Relationship to decedent

Phone

Street address of claimant
City/Town

State

Zip

I am filing this statement as (fill in one only): 
a
Surviving spouse requesting reissuance of a refund check.
b
Personal representative. Attach a court certificate showing your appointment.
c
Claimant for the estate of the decedent (other than above). Complete Schedule A and attach a copy of the death certificate or proof of death. (May
be the formal notification from the appropriate government office (e.g., Department of Defense) informing the next of kin of the decedent's death.)
Attach the requested information, complete Schedule A (if applicable), and sign below.

Schedule A. Complete only if line c above is filled in.
1 Fill in if the deceased left a will. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a Fill in if a personal representative has been appointed for the estate of the decedent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b Fill in if one will be appointed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 2a or 2b is filled in, the personal representative should file for the refund.
3 Fill in if you, as the claimant for the estate of the decedent, will disburse the refund according to the law of the state in which the decedent was
domiciled or maintained a permanent residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If line 3 is not filled in, payment of this claim will be withheld pending submission of proof of your appointment as personal representative or other
evidence showing that you are authorized under state law to receive payment.

Declaration
I hereby make request for refund of taxes overpaid by or in 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

Rev. 8/19