Form Sc8857 - Request For Innocent Spouse Relief Page 4
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414 Provide a daytime telephone number. __________________________
The Department may contact you to ask additional questions or receive clarification of the information provided.
I declare that this return and all attachments are true, correct, and complete. Declaration of preparer (other than
taxpayer) is based on all information of which preparer has any knowledge. To willfully furnish a false or fraudulent
statement to the Department is a crime.
Innocent spouse's signature
Phone
Date
(
)
Taxpayer's email address:
Preparer's email address:
Preparer's
Date
PTIN or FEIN
Check if
signature
self-employed
Paid
Preparer's
Firm's name (or yours
Use Only
if self-employed) and
address
WHEN TO FILE?
Do not file until you receive a notice from the SC Department of Revenue.
WHERE TO FILE?
Please mail the completed Innocent Spouse Relief request to:
ATTENTION: INNOCENT SPOUSE RELIEF
COMPLIANCE AND RECOVERY
PO BOX 11189
COLUMBIA SC 29211-1189
GENERAL INSTRUCTIONS
1. Complete all questions in order for your request to be considered.
2. Attach a SC2848 Power of Attorney form if you are represented by a third party.
3. Please use separate page(s) for any additional information.
4. Keep a copy of this form for your records.
"Claimant agency" means a state agency, board, committee, commission, public institution of higher learning, political
subdivision, or other governmental entity of any state or the United States.
Social Security Privacy Act Disclosure
It is mandatory that you provide your social security number on this tax form. 42 U.S.C 405(c)(2)(C)(i) permits a state to
use an individual's social security number as means of identification in administration of any tax. SC Regulation 117-201
mandates that any person required to make a return to the SC Department of Revenue shall provide identifying numbers,
as prescribed, for securing proper identification. Your social security number is used for identification purposes.
33304023
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