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Ciary (number and street) City or town State TYPE OF ENTITY 1. Decedent s estate 2. Simple trust 3. Complex trust 4. Grantor type trust 5. Bankruptcy estate 6. Qualified funeral trust 7. Other Zip code DECEDENT S ESTATE INFORMATION RESIDENT STATUS If Decedent s estate: Check box if resident and complete the following: Subdivision Code Date of death Domicile of decedent County.
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