Form It-285 - Request For Innocent Spouse Relief (And Separation Of Liability And Equitable Relief) Form Page 2
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2IT-285 (4/05) (back)
Part III Separation of liability
9 Are you divorced from the person listed on line 4 (or is that person deceased)?
Yes
Go to line 12.
No
Go to line 10.
10 Are you legally separated from the person listed on line 4?..................................
Yes
No
Go to line 12.
Go to line 11.
11 Have you lived apart from the person listed on line 4 at all times
during the 12-month period prior to filing this form?...........................................
Yes
Go to line 12.
No
Go to line 13.
12 If you answered Yes at line 9, 10, or 11, you may request separation of liability by marking an X in this box
and attaching a
statement and supporting documentation
. Go to line 13.
(see instructions)
Part IV Equitable relief
13 Do you have an underpayment of tax (that is, tax that is properly shown on your return but not paid) or another tax liability that
qualifies for equitable relief (
)?
see instructions
Yes
You may request equitable relief by attaching
No
You do not qualify for equitable relief
(see instr.).
a statement and supporting documentation
(see instr.).
Part V Allocation of items between spouses
If filing for more than one tax year, complete a separate schedule for each year, no matter which type of relief you are requesting.
Please include copies of all federal W-2 forms, all federal schedules, and copies of any notices from the Tax Department.
(a) Allocated to
(b) Allocated to your
(c) Total
Allocated items
you
spouse or former spouse
(column a and column b)
14
Enter the tax year covered by this schedule
Lines 15a, 15b, and 15c
Income — Allocate separate income to the spouse who
earned it. Allocate joint income, such as interest
earned on a joint bank account, as you determine.
Be sure to allocate all income.
15a Wages ..............................................................................
15b All other income. Identify the type and amount.
15c Total income
...................................
(add lines 15a and 15b)
16
Federal adjustments to income. Allocate separate
adjustments, such as an IRA deduction, to the spouse to
whom they belong .............................................................
17
New York adjustments to income. Allocate separate
adjustments, such as 414(h) contributions and/or pension
exclusions, to the spouse to whom they belong................
18
Nonrefundable credits and other taxes .............................
19
Income tax withheld. Allocate New York State/New York
City/Yonkers income tax withheld to each spouse as
shown on federal Forms W-2. Be sure to attach copies of
these forms to this Form IT-285 ........................................
Need help?
Privacy notification — The Commissioner of Taxation and Finance may collect and
maintain personal information pursuant to the New York State Tax Law, including but
not limited to, sections 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 1142, and
Internet access:
1415 of that Law; and may require disclosure of social security numbers pursuant to
(for information, forms, and publications)
42 USC 405(c)(2)(C)(i).
This information will be used to determine and administer tax liabilities and, when
Fax-on-demand forms:
1 800 748-3676
authorized by law, for certain tax offset and exchange of tax information programs as
well as for any other lawful purpose.
Personal Income Tax Information Center:
1 800 225-5829
Information concerning quarterly wages paid to employees is provided to certain
state agencies for purposes of fraud prevention, support enforcement, evaluation of
From areas outside the U.S. and outside Canada: (518) 485-6800
the effectiveness of certain employment and training programs and other purposes
authorized by law.
Failure to provide the required information may subject you to civil or criminal penalties,
or both, under the Tax Law.
This information is maintained by the Director of Records Management and Data
Entry, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone
1 800 225-5829. From areas outside the United States and outside Canada, call
(518) 485-6800.
Please file this original scannable
2852050094
form with the Tax Department.
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