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                                 New York State Department of Taxation and Finance
                                 Claim for Refund of New York State Estate Tax                                                                                     ET-95
                                                                                                                                                                             (9/14)

Decedent’s last name                                                             First name                                   Middle initial

Social security number ( SSN )                                               Date of death                          Employer identification number ( EIN ) of estate

Executor — If there has been a change of executor and you are submitting Letters Testamentary or Letters of Administration with this form,
indicate in this box the type of letters. Enter  Lif regular, LL if limited letters. If you are not submitting letters with this form, enter  N..............................
 Attorney’s or authorized representative’s       last name  First name                     MI  Executor’s last name                  First name                                      MI

 In care of ( firm’s name )                                                      Mark an   X   If more than one executor, mark an X  E-mail address of executor  
                                                                                 if POA is     in the box ( see instructions )
                                                                                 attached
 Address of attorney or authorized representative                                              Address of executor

 City                                                State                   ZIP code          City                                         State  ZIP code

 PTIN or SSN of attorney or authorized rep.            Telephone number                         Social security number of executor          Telephone number
                                                       (    )                                                                               (    )

Note: Do not file this form to claim a refund that is a result of a federal audit change; you must file an amended Form ET-90 or Form ET-706, 
applicable to the specific date of death (see instructions).

      1.Are you requesting a refund?             (Your answer should beNo to this question if you are filing a protective claim; see instructions )

        Yes: Continue with line 2  .                                                                      No: Complete lines  6and 7.

  2.    Are you protesting either a denied or reduced refund, or a previously-paid bill?
                                                                                                                                                                                      
        Yes: Complete lines3, 4,   5,and  .7                                                              No: Do not file this form. File an amended Form ET-90 
                                                                                                          or Form ET-706.
  3.    Enter the amount of refund claimed.                                      $ 
  4.   Enter the amount of total estate tax paid.                                $
  5.  If protesting a paid bill, enter the assessment ID.                        L-

  6.  You may file this form as a protective claim (see instructions on back) to preserve your rights to a possible refund when there is an 
        unresolved issue, and the statute of limitations is due to expire before the matter is settled.

  7.  Attach a detailed explanation of all facts and figures on which you base your refund or protective claim. 

If an attorney or authorized representative is listed above, he or she must complete the following declaration.
I declare that I have agreed to represent the executor(s) for the above estate, that I am authorized to receive tax information regarding the 
estate, and I am( mark an  Xin all that apply ):              an attorney                      a certified public accountant         an enrolled agent
                                                              a public accountant enrolled with the New York State Education Department
  Signature of attorney or authorized representative                                             Date                         E-mail address of attorney or authorized representative

Certification. I certify that this claim and any attachments are to the best of my knowledge and belief true, correct, and complete.
  Signature of executor                                                          Date          Signature of co-executor                                            Date

 Print firm name if preparer other than executor (or yours if self-employed) EIN               Signature of individual preparing this document other than executor Date

  Address of preparer                                                                 City                State     ZIP code         E-mail address of individual preparing document

 Preparer’s PTIN or SSN                                                                        Preparer’s NYTPRIN

ET-95 (9/14) (back)

                                                              Instructions

Use this form to claim a refund of New York State estate tax only     Preparer information 
for the following types of claims:                                    If you prepared Form ET-95 for the estate and you are not the 
Protest of denied refund — If the Tax Department has denied or        executor, fill in the information requested in the preparer section 
adjusted your refund for any reason other than offsets to amounts     on the front of this form and sign where indicated. Include your 
owed to other agencies or tax liabilities, you may immediately file a federal preparer tax identification number (PTIN) or your social 
formal claim for refund.                                              security number (SSN), and your New York tax preparer registration 
Protective claim * — A protective claim is a refund claim that is     identification number (NYTPRIN) if you are required to have one. 
based on an unresolved issue(s) that involves the Tax Department      Paid preparers can be subject to a penalty for failure to conform 
or another taxing jurisdiction that may affect your New York State    to certain requirements. See TSB-M-09(10)M, Tax Preparer 
estate tax. The purpose of filing a protective claim is to protect    Registration Program, and TSB-M-10(8)M, Enrolled Agents 
any potential overpayment when the statute of limitations is due to   Excluded from the Definition of Tax Return Preparer for the Tax 
expire.                                                               Preparer Registration Program, for more information.
Protest of paid bill * — If the bill was based on Form DTF-960,       Sign this claim and mail to: 
Statement of Proposed Audit Changes; Form DTF-966.1, Notice                  NYS TAX DEPARTMENT 
and Demand for Payment of Tax Due; or Form DTF-961, Notice of                TDAB — ESTATE TAX 
Additional Tax Due, enter your 10-digit assessment ID in the space           W A HARRIMAN CAMPUS 
provided on line 5.                                                          ALBANY NY 12227-2994
* Note: Your protective claim or protest must be filed within 
three years from the time the return was filed or within two years    Privacy notification
from the time the tax was paid, whichever is later. A return filed    New York State Law requires all government agencies that 
prior to the due date is considered to be filed on the due date (Tax  maintain a system of records to provide notification of the legal 
Law, section 683(b)).                                                 authority for any request, the principal purpose(s) for which the 
                                                                      information is to be collected, and where it will be maintained. 
Procedures for reporting federal audit changes                        To view this information, visit our Web site, or, if you do not 
                                                                      have Internet access, call and request Publication 54, Privacy 
See N-14-10, New Procedures for Reporting Federal Audit               Notification. See Need help? for the Web address and telephone 
Changes for New York State Estate Tax Purposes, for specific          number.
instructions on filing an amended Form ET-90 or Form ET-706, 
New York State Estate Tax Return. 
                                                                       
                                                                      Need help?
Executor information
Enter the name (last name first) and other information for the               Visit our Web site at www.tax.ny.gov
executor of the estate. The term executor includes executrix,                •  get information and manage your taxes online
administrator, administratrix, or personal representative of the             •  check for new online services and features
decedent’s estate; if no executor, executrix, administrator, 
administratrix, or personal representative is appointed, qualified,       Telephone assistance
and acting within the United States, executor means any person in 
actual or constructive possession of any property of the decedent.    Estate Tax Information Center:                 (518) 457-5387
If an executor has not been appointed, this form may be signed        To order forms and publications:               (518) 457-5431
and filed by a person having knowledge of all the assets in the 
decedent’s estate. This person must also enter his or her name,       Text Telephone (TTY) Hotline (for persons with 
address, and social security number in the area provided for the        hearing and speech disabilities using a TTY):  (518) 485-5082
executor on the front of this form.                                       Persons with disabilities: In compliance with the 
                                                                          Americans with Disabilities Act, we will ensure that our 
If the estate has more than one executor, mark an  Xin the                lobbies, offices, meeting rooms, and other facilities are
box, enter the name and other information for the primary             accessible to persons with disabilities. If you have questions about 
executor (preferably a person residing in New York State) in the      special accommodations for persons with disabilities, call the 
area provided, and attach a list of each of the other executors       information center.
with their mailing address and social security number if not 
previously submitted. Submit Letters Testamentary or Letters 
of Administration with this form if not previously submitted. It is 
sufficient to have one of the coexecutors sign this form. 

Attorney/representative information
If you, as the executor of the estate, have authorized a person 
to represent you regarding the estate, and you would like the 
department to contact him or her regarding the estate, enter the 
name (last name first) of the attorney, accountant, or enrolled agent 
who is representing you. Also enter the firm’s name, address, 
and telephone number in the areas provided, and have the 
representative sign in the area provided on the front of this form. 
Note: If you are giving a person power of attorney to represent 
you, attach a completed Form ET-14, Estate Tax Power of Attorney, 
if one was not submitted previously. Refer to the instructions on 
Form ET-14 for additional information. 

                   Department of Taxation and Finance
                                                                                              TP-38
                   Change in Mailing Address and Assistance                                                 (10/15)
                   Information for Certain Estate Tax Forms

On July 1, 2008, we changed processing centers. Any 
estate tax form that instructs you to mail the form to:     Need help?
NYS Estate Tax, Processing Center, PO Box 5556, 
New York NY 10087-5556, must be mailed to this address      Visit our Web site at www.tax.ny.gov
instead (see Private delivery services below):              •  get information and manage your taxes online
         NYS ESTATE TAX                                     •  check for new online services and features
         PROCESSING CENTER
         PO BOX 15167                                       Telephone assistance
         ALBANY NY 12212-5167
                                                            Estate Tax Information Center:    (518) 457-5387
Any estate tax form that instructs you to mail the form 
to: TTTB-Estate Tax Audit-855, TTTB-Estate Tax-855,         To order forms and publications:  (518) 457-5431
Transaction and Transfer Tax Bureau-Estate Tax, 
TTTB-Estate Tax Audit, or TTTB-Estate Tax, must be          Text Telephone (TTY) Hotline (for persons with 
mailed to one of these addresses instead:                   hearing and speech disabilities using a TTY): 
                                                            If you have access to a TTY, contact us at 
If you are sending by U.S. Mail:                            (518) 485-5082. If you do not own a TTY, check 
                                                            with independent living centers or community 
         NYS TAX DEPARTMENT                                 action programs to find out where machines are 
         TDAB/ESTATE TAX                                    available for public use.
         W A HARRIMAN CAMPUS
         ALBANY NY 12227-2994                               Persons with disabilities: In compliance with the 
                                                            Americans with Disabilities Act, we will ensure 
If you are sending by a private delivery service:           that our lobbies, offices, meeting rooms, and 
         NYS TAX DEPARTMENT                                 other facilities are accessible to persons with 
         TDAB/ESTATE TAX                                    disabilities. If you have questions about special 
         90 COHOES AVENUE                                   accommodations for persons with disabilities, call 
         GREEN ISLAND NY 12183-1515                         the information center.
Note: Forms mailed to the old address may be delayed in 
processing.
Private delivery services
If you choose, you may use a private delivery service, 
instead of the U.S. Postal Service, to mail in your form 
and tax payment. However, if, at a later date, you need to 
establish the date you filed or paid your tax, you cannot 
use the date recorded by a private delivery service unless 
you used a delivery service that has been designated by 
the U.S. Secretary of the Treasury or the Commissioner 
of Taxation and Finance. (Currently designated delivery 
services are listed in Publication 55, Designated Private 
Delivery Services. See Need help? below for information 
on obtaining forms and publications.) If you have used a 
designated private delivery service and need to establish 
the date you filed your form, contact that private delivery 
service for instructions on how to obtain written proof of 
the date your form was given to the delivery service for 
delivery.