Form 12508 - Questionnaire For Non-Requesting Spouse
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312508
Form
Questionnaire for Non-Requesting Spouse
(Rev. July 2013)
We recognize that some of these questions involve sensitive subjects. However, we need this information to evaluate the
circumstances of the claim and properly determine whether relief should be given. If this form is not completed and
returned, the claim will be considered based on the information available to us.
Questions?
Call the IRS at 1-855-851-2009.
Part I
Tell us about yourself
1.
Your Current Name
Your Social Security Number
Your Current Home Address
Apt. No.
County
(number & street)
City, town or post office box, state and ZIP code
Daytime phone number
(between 6 a.m.
and 5 p.m. Eastern Time)
(
)
2. What is the current status between you and your spouse for the years that relief was requested?
(On this form we refer
to your spouse for the years that relief was requested as that individual.)
Married and living together
Married living apart since
MM / DD / YYYY
Legally separated since
MM / DD / YYYY
Divorced since
MM / DD / YYYY
Widowed since
MM / DD / YYYY
Note: A divorce decree stating you must pay all taxes does not necessarily mean that individual will qualify for relief.
Part II
Tell us about filing the returns and your financial situation for the years listed on the letter. If the
information is not the same for all tax years, please explain. If you need more room to write your
answer for any question, attach more pages. Be sure to write your name and social security number on
the top of all pages you attach.
3. How were both of you involved with preparing the returns during those tax years? Check all that apply and explain, if
necessary. If the answers are not the same for all the years, explain.
You That Individual
Prepared or helped prepare the returns.
Gathered receipts and canceled checks.
Gave tax documents (such as W-2s, 1099s, etc.) to the person who prepared the returns.
Asked the person who prepared the returns to explain any items or amounts.
Reviewed the returns before filing them.
Did not review the returns before filing them.
Was not involved with preparing the return.
Other
Explain, if necessary
12508
Form
(Rev. 7-2013) Catalog Number 28730P
Page 1 of 3
Department of the Treasury – Internal Revenue Service
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