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4          State of Rhode Island Division of Taxation                                                                                                                           4
5          Form RI-1310                                                                                                                                                         5
6          Statement of Claimant to Refund Due - Deceased Taxpayer                      14103899990101                                                                          6
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   Name of decedent                                                                             Date of death                                          Social security number
9                                                                                                                                                                               9
10 XXXXXXXXXXXXXXXXXXXXXX XX XXXXXXXXXXXXXXXXXXXXXX                                     09/06/2022                                                   999999999                  10
11                                                                                                                                                                              11
   Address                                                 City, town or post office                                                                   State ZIP code
12                                                                                                                                                                              12
13 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                          XXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                XX    99999              13
14                                                                                                                                                                              14
15 Name of claimant                                                                                                                                                             15
16 XXXXXXXXXXXXXXXXXXXXXX XX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                                                    16
17                                                                                                                                                                              17
   Address                                                 City, town or post office                                                                   State ZIP code
18                                                                                                                                                                              18
19 XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                          XXXXXXXXXXXXXXXXXXXXXXXXXXXX                                                                XX    99999              19
20                                                                                                                                                                              20
21                                                                                                                                                                              21
22                                                                                                                                                                              22
23 I am filing this statement as (check only one box):                                                                                                                          23
24                                                                                                                                                                              24
25         A           Administrator or executor.  Attach a court certificate showing your appointment.                                                                         25
26                                                                                                                                                                              26
27         B           Claimant, for the estate of the decedent, other than the above.                                                                                          27
28                     Complete Schedule A and attach a copy of the death certificate or proof of death.                                                                        28
29                                                                                                                                                                              29
30                                                                                                                                                                              30
31 Please attach any requested information.  If applicable, complete Schedule A.  All claimants must sign below.                                                                31
32                                                                                                                                                                              32
33 Schedule A - Complete only if you checked “B” above.                                                                                                                         33
                                                                                                                                                 Yes No
34                                                                                                                                                                              34
35         1           Did the deceased leave a will? ..........................................................................................                                35
36                                                                                                                                                                              36
37         2a          Has an administrator or executor been appointed for the estate of the decedent?..........                                                                37
38                                                                                                                                                                              38
39          b          If “No”, will one be appointed?..........................................................................................                                39
40                                                                                                                                                                              40
41          If 2a or 2b is checked “Yes”, do not file this form.  The administrator or executor should file for the refund.                                                     41
42                                            DRAFT                                                                                                                             42
43                                                         IMPORTANT                                                                                                            43
44          If the claimant is a surviving spouse and the decedent dies in the current tax year prior to filing a joint tax return,                                             44
45          this form does not need to be completed.  Check the “deceased” box next to the decedent’s name on your return.                                                      45
46          Enter “Filing as Surviving Spouse” on the signature line for the decedent, then sign on the line provided.                                                          46
47                                                                                                                                                                              47
48                                                         INSTRUCTIONS                                                                                                         48
49          1. Enter the name, date of death, social security number and last known address for the deceased taxpayer.                                                          49
            2. Enter the name and current address of the person or firm to whom the refund is to be paid. 
50                                                                                                                                                                              50
            3. Check off either box A or B.   
51          4. Attach the documentation required.                                                                                                                               51
52                                                                                                                                                                              52
            5. Sign the form and either attach it to the Rhode Island income tax return being filed, or if the return has already          09/01/2023
53            been filed, mail it to the address below.                                                                                                                         53
54                                                                                                                                                                              54
55                                                                                                                                                                              55
56         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                               56
57                     have examined this claim, and to the best of my knowledge and belief, it is true, correct and complete.                                                  57
58  Claimant signature                          Print name                                 Date                                                                Telephone number 58
59                                                                                                                                                                              59
60                                                                                                                                                                              60
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                       Mailing address: RI Division of Taxation, One Capitol Hill, Providence, RI 02908
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