Form N-379 - Request For Innocent Spouse Relief (And Separation Of Liability And Equitable Relief)

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FORM

STATE OF HAWAII - DEPARTMENT OF TAXATION

N-379

REQUEST FOR INNOCENT SPOUSE RELIEF

(REV. 2012)

(And Separation of Liability and Equitable Relief)

(NOTE: References to “married”, “unmarried”, and “spouse” also means “in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)

Do not file this form to request relief from non-tax obligations of your spouse (e.g. child support).

Do not file this form if you did not file a joint return for the year(s) for which you are requesting relief.

Do not file with your tax return. See Separate Instructions.

ATTACH COPY OF FEDERAL FORM 8857

Your Current Name (see instructions)

Your Social Security Number

Your Current Address

City/State/Zip Code. If a foreign address, see separate instructions.

Daytime phone no. (optional)

The Department of Taxation can help you. If you are working with a Department employee, you can ask that employee, or you can call the

Department of Taxation at (808) 587-4242 or toll-free at 1-800-222-3229.



Enter the years for which you are requesting relief from liability of tax.

Have you requested innocent spouse relief from the IRS for the years listed on line 1?



Yes - Attach a copy of the final determination letter you received from the IRS.



Yes - Determination letter not received yet.



No - See the instructions for line 4.

If the liability is from tax reported on the original Hawaii return (not an adjustment made to the tax return), were you aware that the



tax was not paid at the time the return was filed?

Yes

Required attachments - All of the following items must be attached to your Form N-379:

Completed copy of federal Form 8857, Request for Innocent Spouse Relief

A written statement explaining why you believe you qualify for relief. The statement will vary depending on your

circumstances, but should include the following:

•

If you are seeking relief from a tax understatement, the amount and a detailed description of each erroneous item,

including why you had no reason to know about the item or the extent to which you knew about the item,

•

The amount of the understatement or underpayment of tax for which you are liable and are seeking relief,

•

Why you believe it would be unfair to hold you liable for the understatement or underpayment of tax instead of your

spouse (or former spouse), and

•

Information regarding the hardship (financial or personal loss) that you would incur if you were required to pay the liability.

DECLARATION

I declare, under the penalties set forth in section 231-36, HRS, that this form (including any accompanying schedules or statements) has been examined by me and, to the best of

my knowledge and belief, is true, correct, and complete, made in good faith, for the taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS. Declaration of

preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Please



Sign

Here

Your Signature

Date

Preparer’s Signature

Preparer’s identification number



Check if

and date,