Form 8857 - Request For Innocent Spouse Relief, Separation Of Liability, And Equitable Relief Page 4
ADVERTISEMENT
1
2
3
417. Has that individual ever transferred assets to you? (Was something of value, such as real estate or stocks, put in your name rather than in that
individual’s name?)
Yes
List the assets and the dates they were transferred. Explain why the assets were transferred.
_______________________________
_____________________________________________________________________________________________________
No
Part 5: Tell us about your current financial situation
Adults
Children
18. Tell us the number of people in your household.
19. Tell us your current average monthly income and expenses for your entire household. Include income from a spouse or anyone who lives with you.
Monthly income
Amount
Monthly expenses
Amount
Federal, state, and local taxes deducted from
Wages (Gross pay)
your paycheck
Pensions
Rent or mortgage
Unemployment
Utilities
Social security
Telephone
Food
Government assistance, such as housing, food
stamps, grants
Car expenses, payments, insurance, etc.
Alimony
Medical expenses, including medical insurance
Child support
Life insurance
Self-employment business income
Clothing
Rental income
Child care
Interest and dividends
Public transportation
Other income, such as disability payments,
Other expenses, such as real estate taxes, child
gambling winnings, etc. List the type below:
support, etc. List the type below:
Type ________________________________
Type ________________________________
Type ________________________________
Type ________________________________
Type ________________________________
Type ________________________________
Total
Total
Part 6: Sign here
Important note: Even if you are a victim of spousal abuse, by law we must contact the person who was your spouse for the years you want relief.
By signing this form, you understand we will contact that individual about your claim.
Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete.
Sign your
name here
/
/
Date
Part 7: For paid preparers only
Paid Preparer’s name
Preparer’s SSN/PTIN
/
/
Paid Preparer’s signature
Date
Check if you are self employed
Firm’s name
Firm’s EIN
Street address
City
State
ZIP code
page 4 of 4
Form 8857 (Rev. 2006)
Catalog Number xxxxx
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ct-8857 - Request For Innocent Spouse Relief (and Separation Of Liability And Equitable Relief)
Financial
Form Ct-8857 - Request For Innocent Spouse Relief (and Separation Of Liability And Equitable Relief)
Financial
Form Ct-8857 - Request For Innocent Spouse Relief (and Separation Of Liability And Equitable Relief)
Financial
Related Categories
Parent category: Financial