Federal Request for Discharge from Personal Liability Under Internal Revenue Code Section 2204 or 6905

Request for Discharge from Personal Liability Under Internal Revenue Code Section 2204 or 6905
Form 5495 (Rev. December 2008)
Note: The form, instructions, or publication you are looking
for begins after this coversheet.
Please review the updated information below.
Where to file Form 5495
Send your request to the Internal Revenue Service Center where you filed the returns listed on
the front of this form. If you are requesting taxes reported on multiple returns filed at different
Service Centers, you must mail separate Forms 5495 to each Service Center to receive a
discharge from liability for each type of tax. For gift tax discharge on gift tax reported on a Form
709, or when an estate tax return Form 706 has been filed, use the following address:
Internal Revenue Service
Stop 824G
7940 Kentucky Drive
Florence, KY 41042‐2915

Form

5495

(Rev. December 2008)
Department of the Treasury
Internal Revenue Service
Decedent’s name

Request for Discharge From Personal Liability Under
Internal Revenue Code Section 2204 or 6905
▶

OMB No. 1545-0432

For IRS Use Only

See instructions on back.
Social security number

Date of death

Kind of Tax

Requester’s name

Income

Title

Gift
Number, street, and room or suite no. (If a P.O. box, see instructions.)

Estate

City, town, or post office, state, and ZIP code

Daytime phone number

Tax Returns for Which Discharge From Personal Liability is Requested
Form
Number

Tax Period
Ended

SSN/EIN on
Return

Name and Address
Shown on Return

Date
Filed

Service Center
Where Filed

Spouse’s social security number

If applicable, provide the name of the decedent’s spouse (surviving or deceased)

I have attached the items checked to help expedite action on my request.
Copies of returns listed above.
Copies of letters of administration or letters testamentary.
Other (describe):
I request a discharge from personal liability for any deficiency for the kind of tax and periods shown above, as provided by section 2204
or 6905 of the Internal Revenue Code.
Under penalties of perjury, I declare that I have examined this request, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.

Sign
Here

I certify that I have never been assessed any penalties for civil fraud for any federal or state tax matter nor have I been charged with,
indicted for, or convicted of fraud. If you cannot certify this statement, attach a detailed statement explaining the circumstances
under which you were assessed a penalty, charged with, indicted for, or convicted of fraud.

For Privacy Act and Paperwork Reduction Act Notice, see back of form.

Date
Cat. No. 42571S

▲

▲

Signature of requester

Identifying number
Form

5495

(Rev. 12-2008)

Form 5495 (Rev. 12-2008)

Information and Instructions
General Information
Ordinarily, the IRS has 3 years after an income tax, gift
tax, or estate tax return has been filed to assess tax and
demand payment of any deficiency. The executor
representing a decedent’s estate or a fiduciary of a
decedent’s trust may request a discharge from personal
liability for the decedent’s income, gift, and estate taxes.
Nine months, or 6 months in the case of a fiduciary’s
request, after the IRS’s receipt of the request for
discharge or the earlier payment of any amount
determined by the IRS to be owed, the executor or
fiduciary will be discharged from personal liability for any
deficiency in such tax thereafter found to be due. In
certain instances where the date for payment of the
estate tax has been extended, the IRS may require a
bond as a condition for discharge.
An executor means the executor or administrator of a
decedent, who was appointed, qualified, and acting
within the United States.

When To File
Do not file Form 5495 requesting a discharge from
income or gift tax liability until after you file the tax returns
listed on the front of this form. If you are requesting a
discharge from personal liability for the estate tax, you
may attach this form to Form 706, United States Estate
(and Generation-Skipping Transfer) Tax Return, or you
may file this form any time during the 3-year period
following the date the Form 706 is filed. You must submit
a separate request for discharge from personal liability for
any tax returns filed after this Form 5495.

Where To File
Send your request to the Internal Revenue Service
Center where you filed the returns listed on the front of
this form. If you are requesting taxes reported on multiple
returns filed at different Service Centers, you must mail
separate Forms 5495 to each Service Center to receive a
discharge from liability for each type of tax. If an estate
tax return was filed, file Form 5495 for all taxes at the
address where the estate tax return was filed.

What To File
This Form 5495 provides spaces for all information
required to process a request for discharge from
personal liability under IRC section 2204 or 6905. Attach
to your request the information and documentation
requested on Form 5495. If you are submitting this
request with your estate tax return, you will not be
required to provide an additional copy. If, however, this
form is filed after Form 706, then a copy of pages 1–3 and
Schedules A through I of Form 706 must be attached. If
you are a fiduciary requesting discharge from personal
liability under section 2204, check the “Other” box and
include a copy of the trust instrument(s), a list of assets
transferred from this decedent to the trust, and any other
relevant information. If you prefer to use your own
format, your written request must list the same
information as requested on this form and include the
applicable attachments.

Page

2

Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. We collect
this information under the authority of Internal Revenue
Code sections 2204 and 6905. We need it to ensure that
you are complying with these laws and to allow us to
figure and collect the right amount of tax. This
information is needed to determine eligibility for the
requested discharge from personal liability. You are not
required to request discharge from personal liability;
however, if you do so you are required to provide the
information requested on this form. Failure to provide the
information may delay or prevent processing your
request; providing false information may subject you to
penalties. Section 6109 requires you to provide the
requested taxpayer identification numbers.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its
instructions must be retained as long as their contents
may become material in the administration of any Internal
Revenue law. Generally, tax returns and return
information are confidential, as required by section 6103.
However, section 6103 allows or requires the Internal
Revenue Service to disclose or give such information to
the Department of Justice for civil and criminal litigation;
to cities, states, the District of Columbia, and U.S.
commonwealths and possessions to administer their tax
laws; and to other countries under a tax treaty. We may
also disclose this information to federal and state
agencies to enforce federal nontax criminal laws, or to
federal law enforcement and intelligence agencies to
combat terrorism.
The time needed to complete and file this form and
related schedules will vary depending on individual
circumstances. The estimated average times are:
Recordkeeping . . . . . . . . . . 5 hr., 30 min.
Learning about the law
or the form . . . . . . . . . . . 1 hr., 30 min.
Preparing the form . . . . . . . . 4 hr., 27 min.
Copying, assembling, and
sending the form to the IRS . . . . . . . 48 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this form
simpler, we would be happy to hear from you. You can
write to the Internal Revenue Service, Tax Products
Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
Constitution Ave. NW, IR-6526, Washington, DC 20224.
Do not send the tax form to this address. Instead, see
Where To File.