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                           New Hampshire  
                           Department of  
                                                               NH-1310                       *NH13102311862*
                  Revenue Administration
                                                                                                            NH13102311862

                                     REQUEST FOR REFUND DUE FOR A DECEASED TAXPAYER

PRINT OR TYPE                                     MMDDYYYY                                       MMDDYYYY
                           Tax Period Begin Date: 0 1 0 1 2    0     2 3    Tax Period End Date:    1 2   3   1 2   0 2     3

Name of Decedent                                                     Date of Death (MMDDYYYY)       Taxpayer Identification Number
PETER PEPPER                                                           0 1  1 0         2  0 2 3        9   8  7    6 5      4 3  2                 1
Number & Street Address (Permanent or Domicile on the date of death) City / Town                    State      Zip Code + 4 (or Canadian Postal Code)
1067 PINE HILL CREST                                                 PORTSMOUTH                     NH         0 3 8 0 1 - 1 2 9 4

Name of Claimant                                                     Claimant Number & Street Address
SHELDON SMITH                                                        12 OCEAN BLVD APT 4
City / Town                          State        Zip Code + 4 (or Canadian Postal Code)
HAMPTON                              NH             0 3 2 8 1
I am filing this statement as (check only one box):
A.     Surviving spouse, claiming a refund based on a joint return OR received a joint refund check but are requesting a new check in your name 
         only. Attach a copy of the death certificate.
B.       Administrator or executor. Attach a court certificate showing your appointment and death certificate.

 C.      Trustee of the trust. Attach a copy of the certificate of trust, trust affidavit, a copy of the trust, and a copy of the death certificate.

SIGNATURE AND VERIFICATION
I hereby make request for 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.

Signature (in ink) of Claimant                                 Today's Date (MMDDYYYY)
                                                               1 0     2 5  2      0    2 3

                                                               INSTRUCTIONS
WHO MUST FILE 
If you are claiming a refund on behalf of a deceased taxpayer, you must file Form NH-1310. 
WHERE TO FILE 
Mail forms to the New Hampshire Department of Revenue Administration, Taxpayer Services Division, PO Box 3306, Concord, NH 03302-3306. 
FORMS SHALL NOT BE FILED BY FAX OR EMAIL.
LINE A 
Check the box on Line A if you are a surviving spouse filing a joint return but requesting a refund in your name only, or if you received a joint refund 
check but are requesting a new check in your name only. For either request, you must include a copy of the death certificate with a completed Form 
NH-1310. If you are requesting a new check in your name only, you must also return the joint refund check with Form NH-1310. 
LINE B 
Check the box on Line B only if you are the decedent's court-appointed administrator or executor. You must include a copy of the court certificate 
showing your appointment and a copy of the death certificate with the completed Form NH-1310. A copy of the decedent's will cannot be accepted 
as evidence that you are the personal representative. 
LINE C 
Check the box on Line C only if you are the trustee of the trust. You must file a certificate of trust, trust affidavit, a copy of the trust, and a death 
certificate with the completed Form NH-1310. A copy of the decedent's will cannot be accepted as evidence that you are the personal representative. 
NEED HELP? 
Call the Department of Revenue Administration, Taxpayer Services Division at (603) 230-5920.  Individuals with hearing or speech impairments may 
call TDD Access: Relay NH 1-800-735-2964.
     NH-1310
     Version 1   8 0 /2023                                                                                                     Page 1 of 1