Form 12508 (Rev. 7-2013)
Catalog Number 28730P Page 1 of 3 Department of the Treasury – Internal Revenue Service
Form 12508
(Rev. July 2013)
Questionnaire for Non-Requesting Spouse
We recognize that some of these questions involve sensitive subjects. However, we need this information to evaluate the
circumstances of the claim and properly determine whether relief should be given. If this form is not completed and
returned, the claim will be considered based on the information available to us.
Call the IRS at 1-855-851-2009.
Part I Tell us about yourself
1. Your Current Name Your Social Security Number
Your Current Home Address (number & street) Apt. No. County
City, town or post office box, state and ZIP code Daytime phone number (between 6 a.m.
and 5 p.m. Eastern Time)
( )
2. What is the current status between you and your spouse for the years that relief was requested? (On this form we refer
to your spouse for the years that relief was requested as that individual.)
Married and living together
Married living apart since
Legally separated since
Divorced since
Widowed since
Note: A divorce decree stating you must pay all taxes does not necessarily mean that individual will qualify for relief.
Part II Tell us about filing the returns and your financial situation for the years listed on the letter. If the
information is not the same for all tax years, please explain. If you need more room to write your
answer for any question, attach more pages. Be sure to write your name and social security number on
the top of all pages you attach.
How were both of you involved with preparing the returns during those tax years? Check all that apply and explain, if
necessary. If the answers are not the same for all the years, explain.
You That Individual
Prepared or helped prepare the returns.
Gathered receipts and canceled checks.
Gave tax documents (such as W-2s, 1099s, etc.) to the person who prepared the returns.
Asked the person who prepared the returns to explain any items or amounts.
Reviewed the returns before filing them.
Did not review the returns before filing them.
Was not involved with preparing the return.
Explain, if necessary
Form 12508 (Rev. 7-2013)
Catalog Number 28730P Page 2 of 3 Department of the Treasury – Internal Revenue Service
4. When you filed the returns, were any amounts owed to the IRS for those years?
Yes. Explain how the amounts owed were to be paid.
5. When that individual signed/filed any of the returns, was he/she aware of any financial problems you were having (for
example, bankruptcy or bills you could not pay)?
Yes. Explain
Do not know
6. For those years, what kinds of accounts did you have? Check all that apply. Explain if the answers are not the same
for all the years.
Joint Separate
Checking or money market
Savings or certificate of deposit
How did that individual use those accounts? Check all that apply.
Joint Separate
Made deposits
Reviewed bank statements or balanced the checkbook
Paid bills
Knew how much money was in the account
Made withdrawals from the account
Did not know about the account
Did not use the account
Was not involved in handling money for the household
Explain, if necessary
7. Did you ever transfer assets to that individual? (Did you put something of value, such as real estate or stocks, in that
individual's name rather than in your own name?)
Yes. List the assets and the dates they were transferred. Explain why the assets were transferred.
During those tax years, were you self employed?
Yes. Explain how that individual was involved in your business.
Form 12508 (Rev. 7-2013)
Catalog Number 28730P Page 3 of 3 Department of the Treasury – Internal Revenue Service
9. If the tax year(s) in question were audited, what items, if any, changed? Were the changed items yours or that
individual’s? (For example, unreported income, disallowed deductions, unclaimed credits)
10. If the audit results changed your business income or deductions on your tax return, did that individual help you in the
business? If so how? If not, did that individual know about your business affairs? Explain.
11. If the items changed by the audit were yours, did that individual benefit from them? (Example, unreported income
paid for a family vacation, car, jewelry, etc.) Explain.
12. Do you have any other information you want us to consider?
Under penalties of perjury, I declare that I have examined this statement and to the best of my knowledge it
is true, correct, and complete.
Signature Date
Keep a copy for your records. Return the original signed form and any attachments in the enclosed envelope or you may
fax the signed form and attachments to 1-855-233-8558.
dd mmm yyyy
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