Rev. 1/05
                                                              Form M-1310                                         Massachusetts
                            Statement of Claimant to Refund Due                                                   Department of
                                                                                                                  Revenue
                                                              a Deceased Taxpayer
Please print or type. For calendar year , or other taxable year beginning  and ending  
Name of decedent                                                                 Name of claimant

Date of death                          Social Security number                    Number and street

Number and street (Permanent residence or domicile on the date of death)

City or town, state and Zip                                                      City or town, state and Zip

I am filing this statement as (check one box only):
ASurviving wife or husband, claiming a refund based on a joint return.
BAdministrator or executor. Attach a court certificate showing your appointment.
CClaimant, for the estate of the decedent, other than above. Complete Schedule A and attach a copy of the death certificate or proof
 of death.*
Please attach the requested information, complete Schedule A, if applicable, and sign below.
Schedule A.          (To be completed only if item C above is checked.)
1Did the deceased leave a will?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
2 (a)Has an administrator or executor been appointed for the estate of the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                 Yes No
 (b) If “no,” will one be appointed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
 If 2(a) or 2(b) is checked “yes,” do not file this form.The administrator or executor should file for the refund.
3Will you, as the claimant for the estate of the decedent, disburse the refund according to the law of the state
 in which the decedent was domiciled or maintained a permanent residence?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               Yes No
 If “no,”    payment of this claim will be withheld pending submission of proof of your appointment as administrator or
 executor or other evidence showing that you are authorized under state law to receive payment.
4Name of widow or widower                                                        Address

5Names of surviving children                                                     Address

6Name of person supporting the children                                          Address

7Names of decedent’s living father and mother                                    Address

8Name of decedent’s living brothers and sisters                                  Address

9Names of the living children of the decedent’s deceased children                Address

Signature and Verification
I hereby make request for refund of taxes overpaid by or in 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 of claimant                                                                                       Date

*May be the original or authentic copy of a telegram or letter from the Department of Defense notifying the next of kin of his/her death while in active service, or a death certificate
issued by an appropriate officer of the Department of Defense.
Form M-757, Waiver of Claim to Refund Due on Behalf of Deceased, is not required.