Form L-21
O
T
C
klahOma
ax
OmmissiOn
September 2014
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s
R
nnOCenT
pOuse
elief
Name shown on return:
Applicant’s Social Security Number:
Name, if different from that shown on return:
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nfORmaTiOn abOuT The jOinT Tax ReTuRn fOR whiCh yOu aRe seeking Relief
1. Enter the following information exactly as it is shown on the tax return(s) for which you are seeking relief. The
spouse’s name and Social Security Number (SSN) shown first on the tax return(s) must also be shown first below.
Name shown first on return:
SSN shown first:
If requesting relief,
check here ...............
Name shown second on return:
SSN shown second:
If requesting relief,
check here ...............
2. Enter the tax year(s) for which you are seeking relief:
3. What is the current marital status between you and your spouse?
Married and still living together
Married and living apart since .... __________________
mm/dd/yyyy
Attach a photocopy of the death certificate.
Widowed since .......................... __________________
mm/dd/yyyy
Legally separated since ............. __________________
Attach a photocopy of your entire separation agreement.
mm/dd/yyyy
Divorced since ........................... __________________
Attach a photocopy of your entire divorce decree.
mm/dd/yyyy
4. What was the highest level of education you had completed when the return(s) were filed?
High school diploma, equivalent, or less
Some college
College degree or higher.
List any degrees you have: _______________________________________________________________
5. Your current mailing address:
Street (P.O. Box): ____________________________________________________________________________
City: _______________________________________________ State: __________
ZIP: _______________
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llOCaTiOn Of iTems beTween spOuses On The jOinT Tax ReTuRn
Allocated Income (enter separate income that each spouse
earned. Allocate joint income, such as interest earned on a joint
Amount Shown
Allocated to Spouse
Allocated to
bank account, as you determine. Be sure to allocate all income
on Joint Return
Requesting Relief
Other Spouse
shown on the joint return).
1. Income reported on W-2s
2. All other sources of income
(enter each spouse’s separate adjustments
3. Adjustments to income
such as an IRA deduction)
4. Oklahoma income tax withheld
(enter Oklahoma income tax
withheld from each spouse’s income as shown on Forms W-2 and 1099)
5.
IRS adjustments (enter adjustments made by IRS which gave rise to
Oklahoma adjustments and attach any documentation from the IRS
related to such adjustment) Examples: unreported income or denial of
credits taken.