Form 8857 Form 8857 Request for Innocent Spouse Relief

Forrr

8857 I!

( ~ e vJune 2037)
n~~a'trnen
ofl l h p Tre8911q
Inrwral neuanue Serv~ca (99)

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Request for Innocent Spouse Relief
(And Separation of Lia bflity and Equltable Rellef)
b Do not file with your till return.

F See separate instructions.

GMB No. 1545-t5D6

Should you file this form? You must complete this part for each tax year, .

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Important things you should know'
Answe- all the questions on thls form that apply, attach any necessary docun~er~tat~on,
and slgn oh page 4. Do not delay

flllng this form because of mlsslng dccumenlat~on.See instructions.
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By law, the IRS must contact the person who was yollr spn ise for the years you want rely&. -re
W no exceptions,
even for victlrrs of spousal abuse or domestic v~olenceYour personal tnforrnabon [such es your current name, addrehs,
and enptoyer) w ~ lbe
l protected. Howsver, il you peYfion the Tax COJR,your personal irrfonnation n a y be released. See
rnstructlons f ~ details.
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r If you need help, see How To Get He$ In the instructions.

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Enter each lax y e a r y o u want relief.It rs (mportafllto enter the correct y w . For example.
if the IRS used your 2U06 Ir,come tax refund to pay,a
2004 amount you jointly owed.

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enter tax year 2004, not tax year 2006 . . .
. . . . . . . . . .
Caution. The IRS generally cannot collect the amount you owe untll your request for each
year a resolved. However, the U r n the IRS has to collect IS extended. Sea Co:lection
Statute of L~rnitatrorson page 3 of the mstructions.

2

Check the box for each year you would like a refund if you quolify for rehid.You may
be required to provide proof of payment. Fee inslructions . . . . . . . . . b

3

Did the IRS use your share of the joint refund to pay your spouse's past-due debt:
federal taw, state income fax, child s u m , spousal support, o r federal non-tax debt
such as a student loan?
a I' "Yes,"stop here; do not file this lorrr for that fax year. Irlstead, F~lerorm 8379. Sec
iqslructions.
If"No,"30 to line 4 . . . . . . - . . . . . . . . . . . . . .
D i d you file a joint return for the tax year listed on line I?
A "Yes.*skip l17e5 and go to line 6.
If "No," go to line 5 . . . . . . . . . . . . . . . . . . . . .

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If you did not file a joint return for that tax year, were you a resident of Arizona,
California,Idaho, Loursiana, Nevada, New Mexico, Texas, Washington, or Wisconsin?
r If "Yes," see Communiry Property Laws on page 2 of the instructions.
r If "NO" 3n both lines 4 and 5 , stop here. Do not f ~ l ethis form for that tax year
.
'if you want relief b
r nore than 3 years, fill out an additional
-form

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Tell us about yourself
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Y o - ~current
r
name (see instructions)

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our

si?d security number

Y o ~ current
r
home address (number and street). If a P.G. box, see insttuctiol~s.

Apl,

City, town or post afflce, state, and ZIP code. if a foreign addrcss, see i n s t r ~ ~ c t ~ o n s

Best daytime phohe number

County

rlv.

Tell us about you and your spwse for the t a x years you want relief
7

Who was your spouse for the tax years you want relief? F~lea sepalate Form 8857 for tax fears involving differen! spouses or
former spouses.

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Tbat person's current name

numbw ( ~hown)
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Current home address (number and streat) (if known). If a P.O. box, see ~nstructions.

Apt. n3.

City, town or post office, state, and ZIP code. If a foreign address, see ~nstructjons. - 7 - t

day;rne phone number

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For Privacy Act and Papemork Reduction Act Notice, see instructions.

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Form

8857

(Rev

6-70071

Page

Form 6857 (Rer. 6-2000

Note. If you need more room to write yuur answer for aqy qucstion, attach more pages. Re sure
numker on the top of all pages you attach.

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write your name and sccral security

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What is the current marital status between you and the person on line 7?
Married and sllll living together

0 Married and living apart since

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MM

DD

MM

DD

0 Widowed since
13 Legally separated stnce

Y

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W

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Attach a photocopy of t t ~ edeath certiy~ate;nd

will ( ~ one
f
ex~sts)

WW

'-/ .
MM

DD , < ,W*

MM:

/ . ~/
DO';>
WYV

D~vorcedsirce

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Attach a photocopy of your enup separation agreement

Attach a photucopybf your entire dlvcrce decree.

Note. k divorce decree stating that your f m ' e r spouse must pay all taxes does nct necessarily mean you qualify for relief.
9

What was the highest level of education you had
c+pleted
,
,
for all tax years, explain.

0
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when the retum(s) were filed? If me answers are not tt~ssame

Hrgh school dlploma, equ~valerlt,or less
Some colkge
Collese degree or higher. L~stany degrees you have b ............

List any college-level business or tax-related courses you comp1e;ed k ..................................................................

10

Were you a victim of spousal abuse or domestic violence during any of the tax years you want relieelf the answers are not
the sane for all the tax years, explain.
Yes. Attach a statement to explain the situation and when 11 started Provide photocapies at any doc~rnentat~ori,
such as
pcllce reports, a restraining order, a doctor's report or letter, nr a notariza statement from someone who was aware of the
s~tuation.

cl No.
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Did you sign the return{s)?If the answers are not the same for all t h e tax years, explain.
Yes. If you were forced to sign under threat of hair??(duress),check here b
See instructions.

n.

Nu. Your signature was forged. See indrilct~ons.

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When any of the returns were signed, did you have a mental or physical health problem or do you have a mental or physical
heatlh problem now? If the answers are not tho anmc for all tho t a x years, awyhain.

0 Yes. Attach a statement to explain the problem and when it started. Provide photocopies of any documentation, such as
medical bills or a doctor's report or letter.

No.

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lus how
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you were involved with finances and preparinq return for those tax years
How were you involved with preparing the returns? Check all that apply and explain, if necessary. If the answers are not the
same for all the tax years, explain.
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You filled out or helped fill out the returns.
You gathered receipts and cancelled checks.
You gave tax docr~rnonts(such as Forms W-7. 7099.etc.) to the person who prepard the returns.
You revleiwed the returns before they were signed.
You did rot revrew Ihe returns before they were slgned. Explain below.
You were not involved in preparlng the returns.
Other b ........................................................
Explain how you were invnlved b
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Form

8857

(Rev. 6-200T1

Form 8857 (Rev. 6-2007)

Page

3

Note. If you reed more room to wrlte your answer fur any quesi~on,attach more pages. 80 sure lo write your name and social security
number on the top of all pages you attach.

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When the returns were signed, were you concerned that any of the returns were i n c o r d or missing information? C h e ~ k
all that spply and explair, if necessary. If the answers are not the same for all the tax years, explain.
You knew sornethmg was irrcurrecl or rnisslng, but you sad nothing.
You knew something was incorrect or missing and asked about it.

n Y m did not know anything was ~ncor-ector mbsslng+
Explain b...........................................................

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"----.--T--------.------2-.---.----------When any of the returns w e n i g m d , what did you i,& =bout the income of md&n6n i h n e , nlf the answers are not
,,
the same for all tax years, explai?.
You knew that Derson had income.
of CflCOme on a separate line. lExampks are wages, soc!al securtfy, gainblli@ w~lmii!ys,or self-amploymont business Incone > E n t ~ o
r ~ch
tax year and the amount of income for each type you listed It yod do ~ 0 m1 w any cetalls,mt8r "I don't know
C ~ seach
t

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Type 01 bncorne

Who p a ~ dit to that p
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W

: Tax Year l

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0 Yod knew that person was self-employed and you helped wilh the books and records.
You knew that person was self-employed and you did not help with the books and records.
You knew that person had r o income.
You clrd no1 krww lf that person had income.
Explain F

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When the returns were signed, did you know any amounts were owed to the 1RS for those tax ycers3lf lhe answers are not
the same lor all tax years, explan.
Yes. Expla:n when and how you thnslght the amount of tax reported on Ihe relum would be paid b .............................
.............................................................................................................................................
No.
Explain b

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When any of the returns were signed, were you having financial problems (for sxample. bankruptcy or b~llsyou could not pay)?

If the answers are not the same for all tax years, explain.
Yes. Explain b............................................................................................................................
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No.

D,CInot know.
Expla~nb .....................................................................................................................................
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For the years you want relief, how were you involved in the hourehold finances? Check all that apply. If the answers are not
the same for all the tax years, explain.
You knew the person on line 7 had separate accounts.
U You had jsint accounts but you had limited use ui them or dld not use thorn. Explain below
You used joint accounts. You made deposi~s,paid b~lls,balanced the checkbook, or reviewed the monthly bank statements.
Vou made decisions about how money was spent. For example, you paid bills or made decisions about household purchases.
You were not invclved In handl~ngmoney for the household.
Other b
Expla~nanyth~ngelse you warlt to tell ts about your household finances b .......................................................

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Has the person on line 7 ever transferred assets (money or propem to you?(Property inclu&s real estate, stocks, boids, or
other property to which you have title.] See instruct~oris.
Ves. L ~ sthe
t assets and the dates they were transferred. Explain why the assets were transferred k..............................

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a No.

Form

8857

(Rev 6-200?i

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Tell us the number of people currently in your household.

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Tell us your current average montHy income and expenses for your entire household. If family or friends are helplrlg to support
you, qncluile the drrlounr of support as gifts under Monthly income. Under Monthly qpenses, enter all expenses, including expenses
pa~d
with Income from gins.
r*

Adults

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Monthly expenses

Amount

Monthly lncome

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. . . . . . .
. . . . . . . . . . . .

Unemplcyment . . . . . . . ', .
Social security . . . . . .
.
Government assistance, such as housing';
food stamps, grants . . . . . . .
Alimony

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. Child support.

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Food . , . . . . . . . . . . .
Car expen~es,payments, Insurance, etc.

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Publictransportation

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Other expenxs, such as real estate
taxes, chiid support, etc.
List the type below:

Mst the type below:

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htedical expenses, Including rnd~cal
insurance . . . . . . . . . .
Ltte insurance
Clothing .
Child care

Self-employment business income , .
Rental income . . . . . . . . .
Interestanddividends . . . . . .
Qthec income, such as disability
payments, gambling winnings, etc.

Type ........................................

-ype ................. ...................

Type ........................................

Type .....................................

Type ........................................

T y p e .....................................

-Total

-Amount

Federal, state, and local taw3 deducted
from your paycheck - . . . . . . . .
Rsnt or nortgage" . "p.
:, . .
Ut~lit~es .
. . P'. . . . . . .
Telephone
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Gr'ts
Wages (Gross pay)
Penslous

1;

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Total

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Please provide any other information you want us to consider. If you need more room, attach more ?ages. Be suw to w r ~ t eyou1
7amc and socral sec-lrity number on the :op of all pages you attach.

Caution
By signrng this 'arm, you understany that, by Qw, w e must contact the penon on line 7.See ~nstructiansfor detarls.

Sign
Here
Keep a copy
lor y m

Ilnder xnalties of perjury. I deslare Ihat I have e~aminedthis form and any acmmpanylng schfdules and statements, and to
me best of my knowledge and bellet, they me true, corre-;t, aruJ complete Oeclaratiorl of preparer (other than taxpayer) 1s based
on all informat~mof which preparer has any kngwledgt:
Date

Your signature

~ c uds.
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Paid

Use Only

Preparar s
slgr ature

Date

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check

Prepdrer's DSN or

~ ~ ~ ( o r r y o ; ~ ~
it self-emplcyed).
a d c r e ~an?
~ Z1P c d e

WIN

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