Form Sc8857 - Request For Innocent Spouse Relief Page 3
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4Part V
Tell us the number of people currently in your household.
11 Tell us the number of people currently in your household.
Adults
Children
12 Tell us your current average monthly income and expenses for your entire household. If family or friends are helping to
support you, include the amount of support as gifts under Monthly income. Under Monthly expenses, enter all expenses,
including expenses paid with income from gifts.
Monthly income
Amount
Monthly expenses
Amount
Federal, state, and local taxes deducted
Gifts
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
from your paycheck
Wages (Gross pay)
Rent or mortgage
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
Pensions
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Utilities
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unemployment
. . . . . . . . . . . . . . . . . . . . . . . .
Telephone
. . . . . . . . . . . . . . . . . . . . . . . . . .
Social security
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Government assistance, such as housing,
Food
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
gambling winnings, etc.
. . . . . . . . . . . . . . . . . .
taxes, child support, etc.
. . . . . . . . . . . . . . .
List the type below:
. . . . . . . . . . . . . . . . . . . . .
List the type below:
. . . . . . . . . . . . . . . . . . .
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Type
Type
Type
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Type
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Type
Type
Total
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total
. . . . . . . . . . . . . . . . . . . . . . . . . .
13 Please provide any other information you want us to consider in determining whether it would be unfair to hold you
liable for the tax. If you need more room, attach more pages. Be sure to write your name and social security number on the top
of all pages you attach.
33303025
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Parent category: Financial