VT Form 176 "Statement of Claimant to Refund Due on Behalf of Deceased Taxpayer" - Vermont

What Is VT Form 176?

This is a legal form that was released by the Vermont Department of Taxes - a government authority operating within Vermont. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2012;
  • The latest edition provided by the Vermont Department of Taxes;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of VT Form 176 by clicking the link below or browse more documents and templates provided by the Vermont Department of Taxes.

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Download VT Form 176 "Statement of Claimant to Refund Due on Behalf of Deceased Taxpayer" - Vermont

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Vermont Department of Taxes
133 State Street
Phone: (802) 828-6820
Montpelier, VT 05601-0547
STATEMENT OF CLAIMANT TO REFUND DUE
F
orm
V
ermont
176
ON BEHALF OF DECEASED TAXPAYER
Decedent’s Name
Social Security Number
Address at Time of Death
Date of Death
City
State
ZIP Code
Claimant’s Name
Social Security Number
Address
Relationship or other capacity
City
State
ZIP Code
A. Has an executor or administrator been appointed for the estate of the above-named decedent?
 Yes*.
 No. Will an executor or administrator be appointed for the estate? . . . . . . . . . . . . . . . .  Yes*
 No
* If you answered “Yes” to either of these questions, the executor or administrator must file for the refund.
B. Did the decedent have, at the time of his/her death, any interest in real estate, stocks, bonds,
joint bank accounts or property, trusts, partnerships, or through power of appointment, either
as joint beneficiary, joint tenant, or tenant by the entirety with right of survivorship?
 Yes. What was the total value of those assets at time of death? . . . . . . . . . . . . . $_______________________
 No.
SIGNATURE OF CLAIMANT
I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, I declare that I have
examined this claim, and to the best of my knowledge and belief, it is true, correct, and complete.
Date
Daytime Telephone Number
SIGN
HERE
Form 176
Rev. 04/12
Vermont Department of Taxes
133 State Street
Phone: (802) 828-6820
Montpelier, VT 05601-0547
STATEMENT OF CLAIMANT TO REFUND DUE
F
orm
V
ermont
176
ON BEHALF OF DECEASED TAXPAYER
Decedent’s Name
Social Security Number
Address at Time of Death
Date of Death
City
State
ZIP Code
Claimant’s Name
Social Security Number
Address
Relationship or other capacity
City
State
ZIP Code
A. Has an executor or administrator been appointed for the estate of the above-named decedent?
 Yes*.
 No. Will an executor or administrator be appointed for the estate? . . . . . . . . . . . . . . . .  Yes*
 No
* If you answered “Yes” to either of these questions, the executor or administrator must file for the refund.
B. Did the decedent have, at the time of his/her death, any interest in real estate, stocks, bonds,
joint bank accounts or property, trusts, partnerships, or through power of appointment, either
as joint beneficiary, joint tenant, or tenant by the entirety with right of survivorship?
 Yes. What was the total value of those assets at time of death? . . . . . . . . . . . . . $_______________________
 No.
SIGNATURE OF CLAIMANT
I request a refund of taxes overpaid by or on behalf of the decedent. Under penalties of perjury, I declare that I have
examined this claim, and to the best of my knowledge and belief, it is true, correct, and complete.
Date
Daytime Telephone Number
SIGN
HERE
Form 176
Rev. 04/12