Nebraska Statement of Person Claiming Refund Due a Deceased Taxpayer

Statement of Person Claiming Refund Due a Deceased Taxpayer
Form 1310N
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Statement of Person Claiming
Refund Due a Deceased Person

FORM

1310N

Before You Begin: If you are a surviving spouse filing a joint return with the deceased person, do not file Form 1310N.
Paper filers, write “surviving spouse” on the signature block of Form 1040N or 1040XN.
Tax Year Deceased Person was Due a Refund
Calendar Year 20
       , or Other Tax Year Beginning	     
	 Name of Deceased Person	

and Ending	
Date of Death	

Deceased Person’s Social Security Number

	 Name of Person Claiming Refund (Claimant)		

Claimant’s Social Security Number

	 Home Address of Claimant (Number and Street)
	 City	

State	

Zip Code    

Part I

Check only one box. If you check box C, you must also complete Parts II and III below.

A	

Surviving spouse requesting reissuance of a refund check (see instructions).

B	

Court-appointed or certified personal representative (defined below). Attach a court certificate showing your
appointment (see instructions).

C	

All other persons requesting a deceased taxpayer’s refund. Complete Parts II and III below and attach a copy of
one of the following:
• Death certificate (need not be certified); or
• Formal notification from the appropriate government office (for example, Department of Defense, Department of
Health and Human Services, Department of State, etc.) informing the next of kin of the deceased person’s death.

Part II

Complete only if you checked Part I, box C above.

1	 Did the deceased person have a will?....................................................................................	YES	NO
2	a	 Has a court appointed a personal representative for the estate of the deceased person?	

YES	

NO

b	 If you answered “No” to 2a, will one be appointed?..........................................................	YES	NO
		 Note: If you answered “Yes” to either 2a or 2b, the personal representative must file for the refund.
3	 As the claimant, do you agree to pay out the refund according to the laws of the state
where the deceased person was a legal resident?................................................................	YES	NO
If you answered “No” to 3, a refund cannot be made until you submit a court certificate showing your appointment as
personal representative or other evidence that you are entitled under state law to receive the refund.

Part III

Signature and verification. All claimants must complete this.
I request a refund of taxes overpaid by, or on behalf of, the deceased person. Under penalties of perjury, I declare that I have examined
this claim and the attached Nebraska individual income tax return, and to the best of my knowledge and belief, it is true, correct, and complete.

sign
here

(
Signature of Claimant

Date	

)

Daytime Phone

Print Name

Mail this claim to: Nebraska Department of Revenue, PO Box 98911, Lincoln, NE 68509-8911.
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
8-226-1972 Rev.   1-2022
Supersedes 8-226-1972 Rev. 12-2019

Instructions
Who Must File. If you are claiming a refund on behalf of a deceased taxpayer, you must file Form 1310N unless either of
the following applies:
		 P	
You are a surviving spouse filing an original or amended joint return with the deceased person, or
		 P	
You are a personal representative (defined on this page) filing an original Form 1040N for the deceased person and a
court certificate showing your appointment is attached to the return.
When and Where to File. If you are e-filing the income tax return, Form 1310N and required supporting documentation
may be submitted as an attached PDF document if your software supports these types of attachments. If the supporting
documentation is not received with the return, the Nebraska Department of Revenue (DOR) may request the required
documentation during the processing of your return. This may result in a delayed refund.
If you are filing a paper income tax return, you must attach Form 1310N, and any other required documentation, to the
deceased person’s Nebraska Individual Income Tax Return, Form 1040N or 1040XN, and mail to:
	
Nebraska Department of Revenue
	
PO Box 98911
	
Lincoln, Nebraska 68509‑8911
Personal Representative. For purposes of this form, a personal representative is the executor or administrator of the
deceased person’s estate, as appointed or certified by the court. A copy of the deceased person’s will cannot be accepted as
evidence that you are the personal representative.

Specific Information
Part I, Box A, Surviving Spouse. Check box A if you received a refund check in your name and your deceased spouse’s
name. You can return the joint-name check with Form 1310N to:
Nebraska Department of Revenue
PO Box 98911
Lincoln, Nebraska 68509‑8911.
A new check will be issued solely in your name and mailed to you.
Part I, Box B, Personal Representative. Check box B only if you are the deceased person’s court‑appointed or
certified personal representative claiming a refund for the deceased person on Form 1040N or Form 1040XN. A copy of
your appointment, as described above, must be attached to the return being filed.
Part I, Box C, All Other Persons. Check box C if you are not a surviving spouse claiming a refund based on a joint return
and there is no court-appointed or certified personal representative. Claimants may be any person in charge of the deceased
person’s affairs. Complete Parts II and III.
Attach a copy of the following forms of proof of death:
	 P	 Death certificate (need not be certified); or
	 P	 The formal notification from the appropriate government office (for example, Department of Defense, Department of
Health and Human Services, Department of State, etc.) informing the next of kin of the deceased person’s death.
If you have already sent proof of death to DOR, write “Proof of Death Previously Filed” at the bottom of the form when
filing Form 1310N.
		Example. Mr. Brown died on August 23. His son is his sole survivor. Mr. Brown did not have a will and the court
did not appoint a personal representative for his estate. Mr. Brown was entitled to a $330 refund. To receive the
refund, his son must complete and attach Form 1310N to his father’s final income tax return. He must check box C of
Form 1310N, answer all the questions in Part II, and sign his own name in Part III. He must also attach a copy of the
death certificate or other proof of death.
Part II, Lines 1-3. If you check box C, you must complete lines 1 through 3 of Part II.
Part III. All filers of Form 1310N must complete this part.