Form 12510 - Questionnaire For Requesting Spouse - 2004 Page 3
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411. What was your highest level of education during the year(s) you are requesting relief?
Note any business or tax-related courses you completed by that time.
12. What was your (ex)spouse's highest level of education during the year(s) you are requesting relief?
Note any business or tax-related courses he or she completed by that time.
12a. Have any assets been transferred from your (ex)spouse to you?
Yes
No
If yes, list the assets and the date of transfer. Explain why they were transferred to you.
13. How was the money from the unpaid taxes spent?
14. Explain any other factors you feel should be considered for granting relief.
Part 2 – Complete this part if you are requesting relief for a balance due shown on your return when filed, but not paid.
1. At the time you signed the return(s) did you know there was a balance due?
Yes
No
1a. If no, explain why you did not know.
1b. If yes, explain when and how you thought it would be paid.
2. At the time you signed the return, did you know about any financial problems you and your (ex)spouse were having
such as a bankruptcy, high credit card debt or difficulty in paying monthly living expenses?
Yes
No
If yes, please describe them.
3. After the return(s) was filed, what efforts were made by you and your (ex)spouse to pay the tax?
Part 3 – Complete this part if you are requesting relief for additional tax as a result of an IRS examination
1. List all places of employment of your (ex)spouse for year(s) in questions.
2. Was your (ex)spouse self-employed?
Yes
No
2a. If your (ex)spouse was self-employed, did you assist him/her with the business?
Yes
No
2b. If yes, what were your duties or responsibilities?
12510
Catalog Number 28752D
Page 3 of 4
Form
(Rev. 1-2004)
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