Download:
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pdfVersion A, Cycle 2
8857
Form
(Rev. June 2010) August
Department of the Treasury
Internal Revenue Service (99)
Request for Innocent Spouse Relief
this form
OMB No. 1545-1596
See separate instructions.
Do not file with your tax return.
©
©
Important things you should know
• Do not file with your tax return. See Where To File in the instructions.
• Answer all the questions on this form that apply, attach any necessary documentation, and sign on page 4. Do not delay
filing this form because of missing documentation. See instructions.
• By law, the IRS must contact the person who was your spouse for the years you want relief. There are no exceptions,
even for victims of spousal abuse or domestic violence. Your personal information (such as your current name, address,
and employer) will be protected. However, if you petition the Tax Court, your personal information may be released,
unless you ask the Tax Court to withhold it. See instructions for details.
• If you need help, see How To Get Help in the instructions.
Part I
1
DRAFT AS OF
April 27, 2010
Should you file this form? You must complete this part for each tax year.
Enter each tax year you want relief. It is important to enter the correct year. For example,
if the IRS used your 2009 income tax refund to pay a 2007 tax amount you jointly owed,
enter tax year 2007, not tax year 2009 . . . . . . . . . . . . . . . . ©
Tax Year 1
Tax Year 2 Tax Year 3*
Yes
Yes
1
Caution. The IRS generally cannot collect the amount you owe until your request for each
year is resolved. However, the time the IRS has to collect is extended. See Collection
Statute of Limitations on page 3 of the instructions.
2
Check the box for each year you would like a refund if you qualify for relief. You may
be required to provide proof of payment. See instructions . . . . . . . . . . ©
3
Did the IRS use your share of the joint refund to pay any of the following past-due
debts of your spouse: federal tax, state income tax, child support, spousal support, or
federal non-tax debt such as a student loan?
2
No
No
Yes
No
• If “Yes,” stop here; do not file this form for that tax year. Instead, file Form 8379. See
, Injured Spouse Allocation
instructions.
4
• If “No,” go to line 4 . . . . . . . . . . . . . . . . . . . . . .
Was a return claiming married filing jointly status filed for the tax year listed on line 1?
See instructions.
• If “Yes,” skip line 5 and go to line 6.
• If “No,” go to line 5 . . . . . . . . . . . . . . . . . . . . . .
3
4
was not filed
5
If you did not file a joint return for that tax year, were you a resident of Arizona,
California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin?
• If “Yes,” see Community Property Laws on page 2 of the instructions.
• If “No” on both lines 4 and 5, stop here. Do not file this form for that tax year . . . .
5
*If you want relief for more than 3 years, fill out
an additional form.
Part II
6
Your current name (see instructions)
Your social security number
Your current home address (number and street). If a P.O. box, see instructions. mailing
Apt. no.
City, town or post office, state, and ZIP code. If a foreign address, see instructions.
Best daytime phone number
Part III
7
Tell us about yourself
County
Tell us about you and your spouse for the tax years you want relief
Who was your spouse for the tax years you want relief? File a separate Form 8857 for tax years involving different spouses or
former spouses.
That person’s current name
Social security number (if known)
Current home address (number and street) (if known). If a P.O. box, see instructions.
City, town or post office, state, and ZIP code. If a foreign address, see instructions.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 24647V
Apt. no.
Best daytime phone number
Form
8857 (Rev. 6-2010)
8
Version A, Cycle 2
Form 8857 (Rev. 6-2010)
8
Page 2
Note. If you need more room to write your answer for any question, attach more pages. Be sure to write your name and social security
number on the top of all pages you attach.
Part III
8
(Continued)
What is the current marital status between you and the person on line 7?
Married and still living together
Married and living apart since
MM
DD
YYYY
MM
DD
YYYY
MM
DD
YYYY
Widowed since
Attach a photocopy of the death certificate and will (if one exists).
Legally separated since
Divorced since
Attach a photocopy of your entire separation agreement.
Attach a photocopy of your entire divorce decree.
DRAFT AS OF
April 27, 2010
MM
DD
YYYY
Note. A divorce decree stating that your former spouse must pay all taxes does not necessarily mean you qualify for relief.
9
What was the highest level of education you had completed when the return(s) were filed? If the answers are not the same for all
tax years, explain.
High school diploma, equivalent, or less
Some college
College degree or higher. List any degrees you have ©
List any college-level business or tax-related courses you completed
Explain
10
©
©
Were you a victim of spousal abuse or domestic violence during any of the tax years you want relief? If the answers are not the
same for all tax years, explain.
Yes. Attach a statement to explain the situation and when it started. Provide photocopies of any documentation, such as police
reports, a restraining order, a doctor’s report or letter, or a notarized statement from someone who was aware of the situation.
No.
See new question 11 on attachment.
12 11 Did you sign the return(s)? If the answers are not the same for all tax years, explain.
Yes. If you were forced to sign under duress (threat of harm or other form of coercion), check here ©
. See instructions.
No. Your signature was forged. See instructions.
13 12
When any of the returns were signed, did you have a mental or physical health problem or do you have a mental or physical
health problem now? If the answers are not the same for all tax years, explain.
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.
Part IV
14
13
Tell us how you were involved with finances and preparing returns 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 tax years, explain.
You filled out or helped fill out the returns.
You gathered receipts and cancelled checks.
You gave tax documents (such as Forms W-2, 1099, etc.) to the person who prepared the returns.
You reviewed the returns before they were signed.
You did not review the returns before they were signed. Explain below.
You were not involved in preparing the returns.
Other ©
Explain how you were involved ©
Form
8857 (Rev. 6-2010)
8
Version A, Cycle 2
Form 8857 (Rev. 6-2010) 8
Page 3
Note. If you need more room to write your answer for any question, attach more pages. Be sure to write your name and social security
number on the top of all pages you attach.
Part IV
(Continued)
15 14 When the returns were signed, were you concerned that any of the returns were incorrect or missing information? Check all
that apply and explain, if necessary. If the answers are not the same for all tax years, explain. what did you know about any
You knew something was incorrect or missing, but you said nothing.
You knew something was incorrect or missing and asked about it.
You did not know anything was incorrect or missing.
Explain ©
16 15
When any of the returns were signed, what did you know about the income of the person on line 7? If the answers are not the
same for all tax years, explain.
Check all that apply and explain, if necessary.
You knew that person had income.
DRAFT AS OF
April 27, 2010
List each type of income on a separate line. (Examples are wages, social security, gambling winnings, or self-employment business income.) Enter each tax
year and the amount of income for each type you listed. If you do not know any details, enter “I don’t know.”
Type of income
Who paid it to that person
Tax Year 1
Tax Year 2
$
$
$
$
$
$
You knew that person was self-employed and you helped with 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 no income.
You did not know if that person had income.
Explain ©
17 16
$
$
$
When the returns were signed, did you know any amount was owed to the IRS for those tax years? If the answers are not the
same for all tax years, explain.
Yes. Explain when and how you thought the amount of tax reported on the return would be paid
No.
Explain
18 17
Tax Year 3
©
©
When any of the returns were signed, were you having financial problems (for example, bankruptcy or bills you could not pay)? If
the answers are not the same for all tax years, explain.
Yes. Explain
©
No.
Did not know.
Explain ©
19 18
For the years you want relief, how were you involved in the household finances? Check all that apply. If the answers are not the
same for all tax years, explain.
You knew the person on line 7 had separate accounts.
You had joint accounts but you had limited use of them or did not use them. Explain below.
You used joint accounts. You made deposits, paid bills, balanced the checkbook, or reviewed the monthly bank statements.
You made decisions about how money was spent. For example, you paid bills or made decisions about household purchases.
You were not involved in handling money for the household.
Other ©
Explain anything else you want to tell us about your household finances ©
20 19
Has the person on line 7 ever transferred assets (money or property) to you? (Property includes real estate, stocks, bonds, or
other property to which you have title.) See instructions. own
Yes. List the assets and the dates they were transferred. Explain why the assets were transferred
No.
that
©
[insert comma]
, and their fair market values on the dates
transferred
Form
8857 (Rev. 6-2010)
8
Version A, Cycle 2
Form 8857 (Rev. 6-2010)
Part V
8
Page 4
Tell us about your current financial situation
21 20
Tell us the number of people currently in your household.
22 21
Tell us your current average monthly income and expenses for your entire household. If family or friends are helping to support
you, include the amount of support as gifts under Monthly income. Under Monthly expenses, enter all expenses, including expenses
paid with income from gifts.
Monthly income
Amount
Monthly expenses
Amount
Gifts
. . . . . . .
Wages (Gross pay) . . .
Pensions . . . . . .
Unemployment . . . .
Social security . . . .
Government assistance, such
food stamps, grants . . .
Alimony
. . . . . .
.
.
.
.
.
as
.
.
Children
Adults
Federal, state, and local taxes deducted
from your paycheck
. . . . . .
. . .
. . .
. . .
. . .
. . .
housing,
. . .
. . .
Rent or mortgage
Utilities
. . .
Telephone
. .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
DRAFT AS OF
April 27, 2010
List the type below:
Life insurance
. . . . . . . .
Clothing . . . . . . . . . .
Child care
. . . . . . . . .
Public transportation . . . . . .
Other expenses, such as real estate
taxes, child support, etc.
List the type below:
Type
Type
Type
Type
Type
Type
Total
22
.
.
.
Food . . . . . . . . . . .
Car expenses, payments, insurance, etc.
Medical expenses, including medical
insurance
. . . . . . . . .
Child support . . . . . . . . .
Self-employment business income . .
Rental income . . . . . . . .
Interest and dividends . . . . . .
Other income, such as disability
payments, gambling winnings, etc.
24
.
.
.
.
.
.
.
.
.
.
.
.
.
Total
©
.
.
.
.
.
.
.
.
.
.
©
Please provide any other information you want us to consider in determining whether it would be unfair to hold you liable for
the tax. If you need more room, attach more pages. Be sure to write your name and social security number on the top of all pages you
attach.
Caution
By signing this form, you understand that, by law, we must contact the person on line 7. See instructions for details.
Sign
Here
Keep a copy
for your
records.
Under penalties of perjury, I declare that I have examined this form and any accompanying schedules and statements, and to
the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based
on all information of which preparer has any knowledge.
©
Date
Your signature
Date
©
Preparer’s
Paid
signature
Preparer’s Firm’s name (or yours
Use Only if self-employed),
address, and ZIP code
©
Check if
self-employed
PTIN
EIN
Phone no.
Form
8857 (Rev. 6-2010) 8
23. Tell us about your assets. Your assets are your money and property. Property includes real estate, motor vehicles, stocks, bonds, and other property that you
own. On an attachment, tell us the amount of cash you have on hand and in your bank accounts. Also give a description of each item of property, the fair market
value of each item, and the balance of any outstanding loans you used to acquire each item. Do not list any money or property you listed on line 20.
11.
Did you (or the person on line 7) incur any large expenses, such as trips,
home improvements, or private schooling, or make any large
purchases, such as automobiles, appliances, or jewelry, during any of the
years you want relief or any later years?
[ ] Yes. Attach a statement describing (a) the types and amounts of the expenses and
purchases and (b) the years they were incurred or made.
[ ] No.
File Type | application/pdf |
File Title | Tax Forms & Publications |
Author | Hayley Mitton |
File Modified | 2010-06-17 |
File Created | 2010-06-17 |