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, State, and Zip code I am filling this statement as (check only one box): A. Surviving wife or husband. Claiming a refund based on your joint return (see instructions) B. Administrator or executor. Attached a court certificate showing your appointment. C. Claimant, 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 request information. Complete Schedule A. If applicable and sign below Schedule A. (T.

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