Form Ct-8857 - Request For Innocent Spouse Relief (And Separation Of Liability And Equitable Relief) Page 3
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17. When any of the returns were signed, what did you know about the income of the nonrequesting spouse? Check all that
apply and explain, if necessary.
You knew the nonrequesting spouse had income.
List each type of income on a separate line. (Examples are wages, social security, gambling winnings, or self-employment
business income.) Enter each tax year and the amount of income for each type you listed. If you do not know any details,
enter “I don’t know.”
Type of income
Who paid it to that person
Tax Year 1
Tax Year 2
Tax Year 3
$
$
$
$
$
$
$
$
$
You knew the nonrequesting spouse was self-employed and you helped with the books and records.
You knew the nonrequesting spouse was self-employed and you did not help with the books and records.
You knew the nonrequesting spouse had no income.
You did not know if the nonrequesting spouse had income.
18. For the years you want relief, how were you involved in the household fi nances? Check all that apply.
You knew the nonrequesting spouse had separate accounts.
You had joint accounts but you had limited use of them or did not use them. Explain below.
You had joint accounts and 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 fi nances: __________________________
_____________________________________________________________________________________________
19. Has the nonrequesting spouse ever transferred assets (money or property) to you? (Property includes real estate,
stocks, bonds, or other property that you own.) See instructions.
Yes. List the assets, the dates they were transferred, and their fair market values on the dates transferred. Explain
why the assets were transferred ___________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
No.
20. Did you (or the nonrequesting spouse) incur any large expenses, such as trips, home improvements, or private schooling,
or make any large purchases, such as automobiles, appliances, or jewelry, during any of the years you want relief or any
later years?
Yes. Attach a statement describing the types and amounts of the expenses and purchases and the years they were
incurred or made.
No.
21. How many people currently live in your household.
Adults ____________
Children ___________
22. Were you a victim of spousal abuse or domestic violence during any of the tax years you want relief? If the answers
are not the same for all tax years, explain.
Yes. Attach a statement to explain the situation and when it started. Provide photocopies of any documentation,
such as police reports, a restraining order, a doctor’s report or letter, or a notarized statement from someone who was
aware of the situation.
No.
Form CT-8857 (Rev. 03/12)
Page 3 of 8
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