Form Ct-8857 - Request For Innocent Spouse Relief (And Separation Of Liability And Equitable Relief) Page 2
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Part VI - Questionnaire
You must answer all questions in this section for your request to be considered properly completed. If the answers to any
questions are not the same for all tax years, use the additional explanation sheet on Page 5 and attach it to your request.
10. Have you applied for Innocent Spouse Relief (Form 8857) with the Internal Revenue Service (IRS)?
Yes
No
If Yes, what is the status of your application with the IRS?
Approved
Denied
Pending
If your application was Approved by the IRS, stop here, and submit a copy of this form and a copy of the fi nal
determination notice from the IRS.
If your application was Denied by the IRS, stop here, and submit a copy of this form and a copy of the fi nal
determination notice from the IRS.
If your application is Pending with the IRS, stop here, and submit a copy of this form and a copy of the fi nal
determination notice from the IRS when it becomes available.
If No, complete lines 11 through 25.
11. How were you involved with preparing the returns? Check all that apply and explain, if necessary.
You fi lled out or helped fi ll out the returns.
You reviewed the returns before they were signed.
You gathered receipts and cancelled checks.
You did not review the returns before they were signed.
Explain below.
You gave tax documents (such as Forms W-2,
You were not involved in preparing the returns.
1099, etc.) to the person who prepared the returns.
Other: Explain how you were involved: ___________________________________________________________
__________________________________________________________________________________________
12. Did you sign the return(s)?
Yes.
Yes, but it was signed under duress (threat of harm or other form of coercion). See instructions.
No. The signature was forged. See instructions.
13. When the returns were signed, did you know any amount was owed to the DRS for those tax years?
Yes. Explain when and how you thought the amount of tax reported on the return would be paid: _____________
_____________________________________________________________________________________________
No.
14. When any of the returns were signed, did you have a mental or physical health problem or do you have a mental or
physical health problem now?
Yes. Attach a statement to explain the problem and when it started. Provide photocopies of any documentation, such
as medical bills or a doctor’s report or letter.
No.
15. When the returns were signed, what did you know about any incorrect or missing information? Check all that apply and
explain, if necessary.
You knew something was incorrect or missing, but you said nothing.
You knew something was incorrect or missing and asked about it.
You did not know anything was incorrect or missing.
16. When any of the returns were signed, were you having fi nancial problems (for example, bankruptcy or bills you could
not pay)?
Yes. Explain: _______________________________________________________________________________
_____________________________________________________________________________________________
No.
Did not know.
Form CT-8857 (Rev. 03/12)
Page 2 of 8
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