5495 Request for Discharge From Personal Liability Under Inte

5495

Form
(Rev. December 2008)

Request for Discharge From Personal Liability Under
Internal Revenue Code Section 2204 or 6905

Department of the Treasury
Internal Revenue Service

©

OMB No. 1545-0432
For IRS Use Only

See instructions on back.

Decedent’s name

Date of death

Social security number

Requester’s name

Kind of Tax
Income

Title
Gift
Number, street, and room or suite no. (If a P.O. box, see instructions.)

Estate

City, town, or post office, state, and ZIP code

Daytime phone number

Tax Returns for Which Discharge From Personal Liability is Requested
Form
Number

Tax Period
Ended

SSN/EIN on
Return

Name and Address
Shown on Return

Service Center
Where Filed

If applicable, provide the name of the decedent’s spouse (surviving or deceased)

Date
Filed

Spouse’s social security number

I have attached the items checked to help expedite action on my request.
Copies of returns listed above.
Copies of letters of administration or letters testamentary.
Other (describe):
I request a discharge from personal liability for any deficiency for the kind of tax and periods shown above, as provided by section 2204
or 6905 of the Internal Revenue Code.
Under penalties of perjury, I declare that I have examined this request, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.

Sign
Here

I certify that I have never been assessed any penalties for civil fraud for any federal or state tax matter nor have I been charged with,
indicted for, or convicted of fraud. If you cannot certify this statement, attach a detailed statement explaining the circumstances under
which you were assessed a penalty, charged with, indicted for, or convicted of fraud.

©

Signature of requester

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Date
Cat. No. 42571S

©

Identifying number
Form

5495

(Rev. 12-2008)

Form 5495 (Rev. 12-2008)

Information and Instructions
General Information
Ordinarily, the IRS has 3 years after an income tax, gift
tax, or estate tax return has been filed to assess tax
and demand payment of any deficiency. The executor
representing a decedent’s estate or a fiduciary of a
decedent’s trust may request a discharge from
personal liability for the decedent’s income, gift, and
estate taxes. Nine months, or 6 months in the case of
a fiduciary’s request, after the IRS’s receipt of the
request for discharge or the earlier payment of any
amount determined by the IRS to be owed, the
executor or fiduciary will be discharged from personal
liability for any deficiency in such tax thereafter found
to be due. In certain instances where the date for
payment of the estate tax has been extended, the IRS
may require a bond as a condition for discharge.
An executor means the executor or administrator of
a decedent, who was appointed, qualified, and acting
within the United States.

When To File
Do not file Form 5495 requesting a discharge from
income or gift tax liability until after you file the tax
returns listed on the front of this form. If you are
requesting a discharge from personal liability for the
estate tax, you may attach this form to Form 706,
United States Estate (and Generation-Skipping
Transfer) Tax Return, or you may file this form any time
during the 3-year period following the date the Form
706 is filed. You must submit a separate request for
discharge from personal liability for any tax returns
filed after this Form 5495.

Where To File
Send your request to the Internal Revenue Service
Center where you filed the returns listed on the front of
this form. If you are requesting taxes reported on
multiple returns filed at different Service Centers, you
must mail separate Forms 5495 to each Service Center
to receive a discharge from liability for each type of
tax. If an estate tax return was filed, file Form 5495 for
all taxes at the address where the estate tax return
was filed.

What To File
This Form 5495 provides spaces for all information
required to process a request for discharge from
personal liability under IRC section 2204 or 6905.
Attach to your request the information and
documentation requested on Form 5495. If you are
submitting this request with your estate tax return, you
will not be required to provide an additional copy. If,
however, this form is filed after Form 706, then a copy
of pages 1–3 and Schedules A through I of Form 706
must be attached. If you are a fiduciary requesting
discharge from personal liability under section 2204,
check the “Other” box and include a copy of the trust
instrument(s), a list of assets transferred from this
decedent to the trust, and any other relevant
information. If you prefer to use your own format, your
written request must list the same information as
requested on this form and include the applicable
attachments.

Page

2

Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. We collect
this information under the authority of Internal Revenue
Code sections 2204 and 6905. We need it to ensure
that you are complying with these laws and to allow us
to figure and collect the right amount of tax. This
information is needed to determine eligibility for the
requested discharge from personal liability. You are not
required to request discharge from personal liability;
however, if you do so you are required to provide the
information requested on this form. Failure to provide
the information may delay or prevent processing your
request; providing false information may subject you to
penalties. Section 6109 requires you to provide the
requested taxpayer identification numbers.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or
its instructions must be retained as long as their
contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and
return information are confidential, as required by
section 6103. However, section 6103 allows or requires
the Internal Revenue Service to disclose or give such
information to the Department of Justice for civil and
criminal litigation; to cities, states, the District of
Columbia, and U.S. commonwealths and possessions
to administer their tax laws; and to other countries
under a tax treaty. We may also disclose this
information to federal and state agencies to enforce
federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat
terrorism.
The time needed to complete and file this form and
related schedules will vary depending on individual
circumstances. The estimated average times are:
Recordkeeping
5 hr., 30 min.
Learning about the law
or the form
1 hr., 30 min.
Preparing the form
4 hr., 27 min.
Copying, assembling, and
sending the form to the IRS
48 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this
form simpler, we would be happy to hear from you.
You can write to the Internal Revenue Service, Tax
Products Coordinating Committee,
SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW,
IR-6526, Washington, DC 20224. Do not send the tax
form to this address. Instead, see Where To File.