Form It-285 - Request For Innocent Spouse Relief (And Separation Of Liability And Equitable Relief) Page 4
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4Page 4 of 4 IT-285 (9/14)
Allocation of items between spouses
If filing for more than one tax year, complete a separate schedule for each year. Include copies of all federal Forms W-2, all federal
schedules, and copies of any notices from the New York State Tax Department.
If you do not have specific information to complete the allocation schedule, mark an X in the box and see instructions.
Allocated to
Allocated to your
Total of
–
–
–
a
b
c
you
spouse or former spouse
column a plus column b
Allocated items
Enter the tax year covered by this schedule
13
Wages ..............................................................................
14
Interest and dividends ......................................................
15
Business income ..............................................................
16
All other income. Identify the type and amount below.
17
Line 17 total ...
Federal adjustments to income. Allocate separate
18
adjustments, such as an IRA deduction, to the spouse to
whom they belong .............................................................
New York adjustments to income. Allocate separate
19
adjustments, such as 414(h) contributions and/or pension
exclusions, to the spouse to whom they belong................
20a Estimated tax payments
..........................
(see instructions)
b Payment made with extension Form IT-370 or using
the online application ........................................................
c Payments made with return ..............................................
d Payments made on assessments (bills)............................
Income tax withheld. Allocate New York State/New York
21
City/Yonkers income tax withheld to each spouse as
shown on federal Forms W-2. Be sure to submit copies
of these forms with this Form IT-285 .................................
Taxpayer sign here
Date
(see instr.)
Paid preparer must complete
Your signature
Preparer’s signature
Preparer’s NYTPRIN
Date
Firm’s name (or yours, if self-employed)
Preparer’s PTIN or SSN
Daytime phone number
Address
Employer identification number
(
)
E-mail:
NYTPRIN
excl. code
Keep a copy of this form for your records.
E-mail:
Where to file
Generally, you should send this form to: NYS Department of Taxation and Finance, PO Box 5120, Albany NY 12205-0120. But, if
you are meeting with a Department of Taxation and Finance employee, or you received a notice of deficiency, or you are using a private
delivery service, see instructions. If you would like the Tax Department to correspond with your representative, you must complete and
submit a power of attorney.
285004140094
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