State of Rhode Island Division of Taxation 
        Form RI-1310 
        Statement of Claimant to Refund Due - Deceased Taxpayer                      14103899990101

Name of decedent                                                                              Date of death                                        Social security number

Address                                                  City, town or post office                                                                 State ZIP code

Name of claimant

Address                                                  City, town or post office                                                                 State ZIP code

I am filing this statement as (check only one box):

        A           Administrator or executor.  Attach a court certificate showing your appointment.

        B           Claimant, for the estate of the decedent, other than the above.  
                    Complete Schedule A and attach a copy of the death certificate or proof of death.

Please attach any requested information.  If applicable, complete Schedule A.  All claimants must sign below.

Schedule A - Complete only if you checked “B” above.
                                                                                                                                             Yes No
        1           Did the deceased leave a will? ..........................................................................................

        2a          Has an administrator or executor been appointed for the estate of the decedent?..........

         b          If “No”, will one be appointed?..........................................................................................

         If 2a or 2b is checked “Yes”, do not file this form.  The administrator or executor should file for the refund.

                                                         IMPORTANT 
         If the claimant is a surviving spouse and the decedent dies in the current tax year prior to filing a joint tax return, 
         this form does not need to be completed.  Check the “deceased” box next to the decedent’s name on your return.  
         Enter “Filing as Surviving Spouse” on the signature line for the decedent, then sign on the line provided. 
                                                          
                                                         INSTRUCTIONS 
         1. Enter the name, date of death, social security number and last known address for the deceased taxpayer. 
         2. Enter the name and current address of the person or firm to whom the refund is to be paid. 
         3. Check off either box A or B.   
         4. Attach the documentation required. 
         5. Sign the form and either attach it to the Rhode Island income tax return being filed, or if the return has already          
                been filed, mail it to the address below.

        I hereby make a request for the refund of taxes overpaid by or on 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.
 Claimant signature                          Print name                                  Date                                                              Telephone number

                    Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908