Form 8379 Injured Spouse Claim and Allocation

Form

8379

(Rev. Novermber 2012)
Department of the Treasury
Internal Revenue Service

Part I

Injured Spouse Allocation
▶

OMB No. 1545-0074

Information about Form 8379 and its separate instructions is at www.irs.gov/form8379.

Attachment
Sequence No. 104

Should You File This Form? You must complete this part.

1 Enter the tax year for which you are filing this form. ▶

Answer the following questions for that year.

2 Did you (or will you) file a joint return?
Yes. Go to line 3.
No. Stop here. Do not file this form. You are not an injured spouse.
3 Did (or will) the IRS use the joint overpayment to pay any of the following legally enforceable past-due debt(s) owed only by your
spouse? (see instructions)
• Federal tax • State income tax • State unemployment compensation • Child support • Spousal support
• Federal nontax debt (such as a student loan)
Yes. Go to line 4.
No. Stop here. Do not file this form. You are not an injured spouse.
Note. If the past-due amount is for a joint federal tax, you may qualify for innocent spouse relief for the year to which the
overpayment was applied. See Innocent Spouse Relief, in the instructions for more information.
4 Are you legally obligated to pay this past-due amount?
Yes. Stop here. Do not file this form. You are not an injured spouse.
Note. If the past-due amount is for a joint federal tax, you may qualify for innocent spouse relief for the year to which the
overpayment was applied. See Innocent Spouse Relief, in the instructions for more information.
No. Go to line 5.
5 Were you a resident of a community property state at any time during the tax year entered on line 1? (see instructions)
Yes. Enter the name(s) of the community property state(s)
Skip lines 6 through 9 and go to Part II and complete the rest of this form.
No. Go to line 6.

.

6 Did you make and report payments, such as federal income tax withholding or estimated tax payments?
Yes. Skip lines 7 through 9 and go to Part II and complete the rest of this form.
No. Go to line 7.
7 Did you have earned income, such as wages, salaries, or self-employment income?
Yes. Go to line 8.
No. Skip line 8 and go to line 9.
8 Did (or will) you claim the earned income credit or additional child tax credit?
Yes. Skip line 9 and go to Part II and complete the rest of this form.
No. Go to line 9.
9 Did (or will) you claim a refundable tax credit (see instructions)?
Yes. Go to Part II and complete the rest of this form.
No. Stop here. Do not file this form. You are not an injured spouse.

Part II

Information About the Joint Tax Return for Which This Form Is Filed

10 Enter the following information exactly as it is shown on the tax return for which you are filing this form.
The spouse’s name and social security number shown first on that tax return must also be shown first below.
First name, initial, and last name shown first on the return

Social security number shown first

If Injured Spouse,
check here ▶

First name, initial, and last name shown second on the return

Social security number shown second

If Injured Spouse,
check here ▶

11 Check this box only if you are divorced or legally separated from the spouse with whom you filed the joint return and
you want your refund issued in your name only . . . . . . . . . . . . . . . . . . . . . . . .
12 Do you want any injured spouse refund mailed to an address different from the one on your joint return?
If “Yes,” enter the address.
Number and street

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Yes

No

City, town, or post office, state, and ZIP code
Cat. No. 62474Q

Form 8379 (Rev. 11-2012)

Page 2

Form 8379 (Rev. 11-2012)

Part III

Allocation Between Spouses of Items on the Joint Tax Return (see instructions)
(a) Amount shown
on joint return

Allocated Items
13

Income:

(b) Allocated to
injured spouse

(c) Allocated to
other spouse

a. Income reported on Form W-2
b. All other income

14

Adjustments to income

15

Standard deduction or Itemized deductions

16

Number of exemptions

17

Credits (do not include any earned income credit)

18

Other taxes

19

Federal income tax withheld

20

Payments

Part IV

Signature. Complete this part only if you are filing Form 8379 by itself and not with your tax return.

Under penalties of perjury, I declare that I have examined this form and any accompanying schedules or 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.
Keep a copy of Injured spouse’s signature
this form for
your records
Print/Type preparer’s name

Paid
Preparer
Use Only

Date
Preparer's signature

Phone number (optional)

Date

Check
if
self-employed

Firm’s name

▶

Firm's EIN

Firm's Address

▶

Phone no.

PTIN

▶

Form 8379 (Rev. 11-2012)