IS Packet - Innocent Spouse Election Packet

PA 8857

(10-09)

Request for Relief from Joint Liability

(Relief from Understatement of Tax, Separation of Liability and Relief by Income Allocation)

PA Department of Revenue Do not file with your tax return. See instructions.

Your name: Your Social Security Number:

Your current address: Apt. number

City, town or post office, state, and ZIP code. If a foreign address, see instructions Daytime phone number

( )

• You may not claim relief from an understatement of Tax, separation of liability or relief by income allocation unless you filed a joint return with

your spouse during the year for which you are claiming relief.

• Do not file this form if you filed a joint return showing an overpayment of tax and all or part of the overpayment is expected to be applied

against your spouse’s past-due Pennsylvania Personal Income Tax or child support liability(ies). Instead, file Form PA 8379, Injured Spouse

Claim and Allocation, to have your share of the overpayment refunded to you.

The Department can help you with your request by calling 717-772-9347.

If you have been a victim of domestic abuse and fear that filing a claim for relief from joint liability

will result in retaliation, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part I 1 Enter the year(s) for which you are requesting relief from liability of tax . . . . . . . . . . . . . . . . . . .

2 Information about your spouse (or former spouse) with whom you filed a joint return for the tax year(s) listed on Line 1.

Name Social Security Number

Current home address (number and street). If a P.O. box, see instructions. Apt. number.

City, town or post office, state, and ZIP code. If a foreign address, see instructions. Daytime phone number (if known)

( )

3 Do you have an Understatement of Tax (that is, the Department of Revenue determined there is a difference

between the amount of tax shown on your return and amount of the tax that should have been shown)?

Yes. Go to Part II. No. Go to Part IV.

Part II 4 Are you divorced from the person listed on Line 2 (or has that person died)?

Yes. Go to Line 7. No. Go to Line 5.

5 Are you legally separated from the person listed on Line 2?

Yes. Go to Line 7. No. Go to Line 6.

6 Have you lived apart from the person listed on Line 2 at all times during the 12-month period prior to

filing this form?

Yes. Go to Line 7. No. Go to Part III.

7 If Line 4, 5, or 6 is Yes, you may request Separation of Liability. If the understatement of tax on the joint return is due in

part, to an item of your spouse, you may request relief by submitting an election packet.

Otherwise check here and go to Part III below.

Part III 8 Is the understatement of tax due to the erroneous items of your spouse (see Page 4)?

Yes. You may request Relief from an Under- No. If Line 6 is Yes, you may request Relief by Income

statment of Tax by submitting an election packet. Allocation. Check here and submit an election packet.

Part IV 9 If you were not a member of your spouse’s household for an entire year before filing this form and you have an

Underpayment of Tax (that is, tax that is properly shown on your return but not paid), check here.

You may request Relief by Income Allocation by submitting an election packet. Otherwise you cannot file this form unless

Line 3 is Yes.

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.

Sign Here Your signature Date

Keep a copy

of this form for

your records

Preparer’s Date Check if Preparer’s SSN or PTIN

signature self-employed

Firm’s name (or yours EIN

if self-employed) and

address

ZIP code

See