Form 12451
(Rev. January 2005)
Request for Relocation Expenses Allowance
Department of the Treasury - Internal Revenue Service
Submit this form only with an application for certificate of Discharge of Property under IRC section 6325(b)(2)(A)
when relocation expenses are being requested in connection with the sale of a principal residence. Any amount
approved will be deducted from sale proceeds and will not reduce the amount of your tax liability. This allowance
is based upon inability to pay relocation expenses and is subject to limitations. To process your request, please
provide the information requested below. If additional information is needed, you will be contacted.
Section I.
Taxpayer Information
1. Taxpayer name 2. Taxpayer identification
number (EIN or SSN)
3. Address of property being sold (Street, City, State, Zip code)
4. Property is principle residence of taxpayer ("X" appropriate box.)
5. Address of new residence (Street, City State, ZIP code)
6. Amount of relocation expenses requested (Please provide sufficient documentation to support requested expenses.)
Section II.
Taxpayer Attestation
Signature of Taxpayer Date
Under penalties of perjury, I declare that I have examined this application,
including all attachments, and to the best of my knowledge and belief, it is
true, correct, and complete.
Form 12451 (Rev. 1-2005)
Catalog Number 28667B
7. This allowance may be granted only when inability to pay relocation expenses is determined by United States.
Please explain your financial circumstances and provide supporting documentation.
b. No (If "No" is checked, a relocation allowance cannot be approved.)a. Yes
click to sign
click to edit
dd mmm yyyy