Form M-8379 Draft - Nondebtor Spouse Claim And Allocation For Refund - 2016
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1Massachusetts Department of Revenue
Form M-8379
Nondebtor Spouse Claim and Allocation for Refund Due
2016
Important: Read the instructions below before completing this form to be sure you are eligible to file.
Tax year of expected refund:
Please print or type. Names and address must appear as they did on the joint return for the tax year in question.
Name
Social Security number
Fill in if nondebtor spouse
Street address
City/Town
State
Zip
Name of spouse (if filing joint return)
Social Security number
Fill in if nondebtor spouse
Name of executor(s) (see instructions)
Designation
Street address
City/Town
State
Zip
c. Joint (as filed)
Allocation items
a. Nondebtor spouse
b. Other spouse
(add col. a and col. b)
11 Total income (list all sources) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
12 Adjustments to income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
13 Deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
DRAFT as of September 13, 2016
14 Exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
15 Credits against tax (do not include Limited Income Credit) . . . . 5
16 Taxes withheld (include copies of all Forms W-2) . . . . . . . . . . . 6
17 Tax payments (amounts paid with return, estimated, etc.) . . . . . 7
Fill in if the refund due is being requested in the nondebtor spouse’s name only.
Are You Eligible to File this Form?
• you, as an individual, filed jointly but made no tax payments for the
tax year at issue; or
You may file this form if:
• you are liable for any past due tax payments to the Common wealth
• you filed a joint Massachusetts tax return with an overpayment ap-
of Massachusetts.
plied against the past due income tax debt of your spouse;
Enter the appropriate information from the tax return in question where
• you received income; and
requested. The Department of Revenue will calculate your nondebtor
• you made tax payments through withholding or estimated tax
refund based on married filing separate status.
payments.
Tax refunds applied to satisfy unpaid debts to other state agencies
You may not file this form if:
must be appealed directly to that state agency. Over pay ments applied
• your joint refund has been or will be applied to past due tax owed
to child support must be appealed to Child Support Enforcement.
jointly to the Commonwealth of Massachusetts;
Mail form to: Massachusetts Department of Revenue, PO Box 7010,
Boston, MA 02204.
Declaration
Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge it is true, correct and complete. Dec lar a -
tion of preparer (other than taxpayer) is based on all information of which the preparer has knowledge.
Signature of nondebtor spouse
Date
Signature of paid preparer
Date
Social Security number
Rev. 5/16
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