Form Pa-1250 - Non-Requesting Spouse Information Request For Innocent Spouse Review printable pdf download

Form Pa-1250 - Non-Requesting Spouse Information Request For Innocent Spouse Review

PA-12508 (04-13)

NON-REQUESTING SPOUSE

DEPARTMENT USE ONLY

INFORMATION REQUEST

OFFICE OF TAXPAYERS'

FOR INNOCENT SPOUSE REVIEW

RIGHTS ADVOCATE

LOBBY STRAWBERRY SQ

HARRISBURG PA 17128

Your Name:

Your Social Security Number:

Please answer all the questions that you can concerning the spouse and tax year(s) referenced in the letter you received

with this form. Some questions may not apply to your particular facts and circumstances or the requested information

may not be available.

1. How did you and your spouse participate in the preparation of the tax return(s) at issue?

2. Did your spouse ask you or your return preparer for an explanation of any items or amounts on the tax return(s)?

3. What is the current marital status between you and your spouse? (Please check or complete the items below that

apply to you).

□

Married . . . . . . . . . . . . . . . . . . . . . . . . . . Date (month, day, year)

□

Divorced . . . . . . . . . . . . . . . . . . . . . . . . . Date (month, day, year)

□

Legally Separated . . . . . . . . . . . . . . . . . . . Date (month, day, year)

□

Living Apart . . . . . . . . . . . . . . . . . . . . . . . Date started (month, day, year)

□

Other (Please explain)

4. Provide copies of any divorce or separation agreements where you or your spouse agreed to pay the taxes for the

year(s) at issue.

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Form Pa-1250 - Non-Requesting Spouse Information Request For Innocent Spouse Review