Form L-21 - Innocent Spouse Relief - Oklahoma Tax Commission Page 2
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Form L-21
nnOCenT
pOuse
elief
Page 2
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nfORmaTiOn RegaRding The OuTsTanding liabiliTy
1. What was the amount of liability you initially owed? ..........................................$
2. Have you made any payments toward the outstanding liability?
Yes (If Yes, provide proof of payment)
No
3. If you have made payments toward the outstanding liability,
what is the amount you currently owe? ...............................................................$
4. Have you requested innocent spouse relief from the IRS?
Yes (If YES, go to line 5)
No (If NO, skip line 5, go to line 6)
5. Have you received a Final Determination letter regarding your request
from the IRS?
Yes (If you have received a Final Determination letter, provide a copy of the
Final Determination letter)
No
6. Are there any tax warrants on file against you in the State of Oklahoma?
Yes
No
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ignaTuRe
Under the penalty of perjury, I declare that I have examined this form and any accompanying schedules or state-
ments, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer
(other than taxpayer) is based on all information of which preparer has any knowledge.
Applicant’s Signature: _________________________________________________
Date: __________________
Phone Number: _____________________________________________________
Preparer’s Printed Name: ________________________________________________________________________
Preparer’s Signature: _________________________________________________
Date: __________________
Firm’s Name: _______________________________________________________
EIN: ___________________
Firm’s Address: ________________________________________________________________________________
City: _____________________________________________ State: _______
ZIP: _______________
Mail completed form to:
Oklahoma Tax Commission
Office of the General Counsel
120 N. Robinson, Suite 2000W
Oklahoma City, OK 73102
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