Arizona Form 200 - Request For Innocent Spouse Relief And Separation Of Liability And Equitable Relief Page 4

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Your Name (as shown on page 1)
Your Social Security Number
If you need more room to write your answer to any question, add more pages. Write your name and social security number on the top of each page you include.
Part 3
(Continued)
15 When any of the returns were signed, were you having financial problems (for example, bankruptcy or bills you could not pay)? If
the answers are not the same for all tax years, explain.
Yes. Explain:
No.
Did not know.
Explain:
16 For the years you want relief, how were you involved in the household finances? Check all that apply. If the answers are not the
same for all tax years, explain.
You knew the person on line 5 had separate accounts.
You had joint accounts but you had limited use of them or did not use them. Explain below.
You used joint accounts. You made deposits, paid bills, balanced the checkbook, or reviewed the monthly bank statements.
You made decisions about how money was spent. For example, you paid bills or made decisions about household purchases.
You were not involved in handling money for the household.
Other:
Explain anything else you want to tell us about your household finances:
17 Has the person on line 5 ever transferred assets (money or property) to you? Property includes real estate, stocks, bonds, or
other property to which you have title. See instructions.
Yes. List the assets and the dates they were transferred. Explain why the assets were transferred.
No.
Continued on page 5 
ADOR 10180 (14)
Page 4 of 5
AZ Form 200 (2014)

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