Pennsylvania Innocent Spouse Election Packet

Innocent Spouse Election Packet
Innocent Spouse Election Packet
(EO) 12-20

PA-8857

REQUEST FOR RELIEF FROM JOINT LIABILITY

OFFICIAL USE ONLY

(Relief from Understatement of Tax, Separation
of Liability and Relief by Income Allocation)

Do not file with your tax return. See instructions.

START
➜

SECTION I

REQUESTER INFORMATION

Name

SSN

Street Address

Apt Number

City, Town or Post Office. If a foreign address, see instructions.

State

ZIP Code

Daytime Phone Number

You may not claim relief from an Understatement of Tax, Separation of Liability or Relief by Income Allocation unless you filed a joint return with your spouse during the year for
which you are claiming relief. Do not file this form if you filed a joint return showing an overpayment of tax and all or part of the overpayment is expected to be applied against
your spouse’s past due Pennsylvania Income Tax, child/spousal support liability(ies), court ordered obligations, or federal income tax debt. Instead, file form PA-8379, Injured
Spouse Claim and Allocation, to have your share of the overpayment refunded to you. The Department can help you with your request by calling 717-772-9347.

SECTION II

SPOUSAL INFORMATION

If you have been a victim of domestic abuse and fear that filing a claim for relief from joint liabiliy will result in retaliation, check here
Enter the year(s) for which you are requesting relief from liability of tax
Information about your spouse (or former spouse) with whom you filed a joint return for the tax year(s) listed above.
Spouse Name (or former spouse)

Spouse SSN (or former spouse)

Street Address

Apt Number

City, Town or Post Office. If a foreign address, see instructions.

State

ZIP Code

Daytime Phone Number

Do you have an Understatement of Tax (that is, the Department of Revenue determined there is a difference between the amount of tax shown on your return and amount of
the tax that should have been shown)?
Yes. Go to Section III
No. Go to Section V

SECTION III

SEPARATION OF LIABILITY INFORMATION

1. Are you divorced from the person listed in Section II (or has that person died)?

Yes. Go to Line 4

No. Go to Line 2

2. Are you legally separated from the person listed in Section II?

Yes. Go to Line 4

No. Go to Line 3

3. Have you lived apart from the person listed in Section II at all times during the
12-month period prior to filing this form?

Yes. Go to Line 4

No. Go to Section IV

4. If Line 1, 2, or 3 is Yes, you may request Separation of Liability. If the Understatement of Tax on the joint return is due in part, to an item of your spouse, you may request
and go to Section IV below.
relief by submitting an election packet. Otherwise check here

SECTION IV

UNDERSTATEMENT OF TAX INFORMATION

Is the Understatement of Tax due to the erroneous items of your spouse (see instructions)?
Yes. You may request Relief from an Understatement of Tax by submitting an election packet.
No. If Section III Line 3 is Yes, you may request Relief by Income Allocation. Check here and submit an election packet.

SECTION V

INCOME ALLOCATION INFORMATION

If you were not a member of your spouse’s household for an entire year before filing this form and you have an Underpayment of Tax (that is, tax that is properly shown on your
return but not paid), check here.
You may request Relief by Income Allocation by submitting an election packet. Otherwise you cannot file this form unless the answer to Section II, Understatement of Tax
question, is Yes.

SECTION VI

CERTIFICATION

Under penalties of perjury, I declare that I have examined this form and any accompanying schedules and statements, and to the best of my knowledge and belief, they are true,
correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Requester Signature
Preparer’s Signature (self employed

Date

Please sign this form after printing
)

Please sign this form after printing

Date

MM/DD/YY

Firm’s Name (or yours if self-employed)

MM/DD/YY

Preparer’s SSN or PTIN
EIN

Firm’s Address
City

State

ZIP Code

KEEP A COPY OF THIS FORM FOR YOUR RECORDS.

Reset Entire Form

Return to top of page.

PRINT FORM

Form PA 12507 (10-09)

INNOCENT SPOUSE STATEMENT

Purpose of form: You can use this form to provide information to the PA Department of
Revenue to consider in determining relief of joint and several liability for the tax year(s) at
issue. NOTE: You can use the back of this page or attach additional pages if you need more
space.
My Name

Social Security Number

Daytime Telephone Number

Best Time to call
INNOCENT SPOUSE STATEMENT

I,

, residing at

make the following statement to be used in the determination of innocent spouse relief for
Mr./Mrs.

Under penalties of perjury, I declare that I have examined this statement, and to the best
of my knowledge and belief, it is true, correct and complete.
Signature

Date

www.revenue.state.pa.us

PA Department of Revenue

Instructions for Form PA-8857
PA-8857 IN (EO) 02-20

GENERAL INFORMATION
You may not claim relief from an understatement of Tax,
separation of liability or relief by income allocation unless
you filed a joint return with your spouse during the year for
which you are claiming relief.
Do not file this form if you filed a joint return showing an
overpayment of tax and all or part of the overpayment is
expected to be applied against your spouse’s past due
Pennsylvania Income Tax, child/spousal support
liability(ies), court ordered obligations, or federal income tax
debt. Instead, file form PA-8379, Injured Spouse Claim and
Allocation, to have your share of the overpayment refunded
to you.
The Department can help you with your request by
calling 717-772-9347.
HOW TO REQUEST RELIEF
File an election packet to request relief for an outstanding
liability from the PA Department of Revenue for the following
three types of relief:
• Understatement of Tax
• Separation of Liability
• Income Allocation
The election packet includes the following forms:
• PA-8857, Request for Relief from Joint Liability
• PA-12507, Innocent Spouse Statement
• PA-12510, Questionnaire for Spousal Relief from Joint
Liability for Requesting Spouse
• REV-488, Statement of Financial Condition for
Individuals.
You may request relief for more than one tax year in a single
election packet.
You must fully complete all of the above forms for a valid
election packet.
ADDITIONAL INFORMATION
See PA-971, Reliet from Joint Liability (Innocent Spouse
Relief), for more details. You can get PA-971 by
downloading from the Department’s home page at
www.revenue.pa.gov or contact the office of Taypayers’
Rights Advocate at 717-772-9347.
WHEN TO FILE
You should file a complete election packet as soon as you
become aware of a tax liability for which you believe only
www.revenue.pa.gov

Request for Relief from Joint Liability

your spouse or former spouse should be held liable. You
must file the packet no later than 2 years after the date the
Department first attempted to collect the tax from you. Some
example of attempts that may start the 2 year period are:
• The mailing of a notice that the Department plans to
intercept your Federal Income Tax refund.
• The issuance of a writ of execution.
The issuance of a billing notice, a preassessment notice, or
an assessment notice is not a collection activity.
You should not file an election packet until the tax for
which relief is requested may no longer be appealed.
Your appeal rights must have expired before you request
relief from joint liability.
WHERE TO FILE
Do not file Form PA 8857 with your tax return or fax it to the
Department. Instead, mail it to:
PA DEPARTMENT OF REVENUE
OFFICE OF TAXPAYERS’ RIGHTS ADVOCATE
STRAWBERRY SQUARE LOBBY
327 WALNUT ST
HARRISBURG PA 17128

DEFINITIONS
UNDERSTATEMENT OF TAX
An understatement of tax is generally the difference
between the total amount of tax that you should have
reported on your return and the amount of tax that you
actually reported. For example, you reported total tax of
$2,500 on your 2005 return. The Department reviewed your
2005 return and determined that the total tax is $3,000. You
have a $500 understatement of tax.
UNDERPAYMENT OF TAX
An underpayment of tax is the amount of tax you reported
on your return, but you have not paid. For example, your
joint 2008 return shows that you and your spouse owe
$5,000. You pay $2,000 with the return. You have an
underpayment of $3,000.
JOINT AND SEVERAL LIABILITY
Joint and several liability applies to all joint returns. This
means that both you and your spouse (or former spouse)
are liable for any underpayment of tax plus any
understatement of tax that may become due later. This is
true even if a divorce decree states that your former spouse
PA-8857

1

will be responsible for any amounts due on previously filed
joint returns.
APPEAL RIGHTS
Review of request for relief for an understatement of tax or
for relief by separation of liability. You may appeal the
Taxpayers’ Rights Advocate’s determination of relief for an
understatement of tax due to an erroneous statement and
relief by separation of liability by filing a petition with the
Board of Finance and Revenue within sixty days of the
mailing date of the notice of final determination.

Department may consider for certain types of relief. You
should fully explain to the Department your concerns in the
statement that you attach to your election.
Enter the current name and SSN of your spouse (or former
spouse) with whom you filed a joint return for the tax year(s)
listed. If the name of the person shown on that year’s tax
return(s) is different from the current name, enter it in
parentheses after the current name. For example, enter
“Jane Maple (formerly Jane Oak).” Also enter the current
address and phone number if you know it.

Taxpayers’ Rights Advocate fails to act. You may also file a
petition with the Board of Finance and Revenue requesting
it to review your request for relief if the Department has not
provided you a final determination within six months from
the date you filed a complete election packet.

PO BOX
Enter the box number instead of the street address only if
you do not know the street address.

Review of request for relief by income allocation. There is
no right to appeal the Taxpayers’ Rights Advocate’s denial
of a request for relief by income allocation.

SEPARATION OF LIABILITY
You may elect separation of liability relief if you meet one of
the following conditions at the time you file the election packet:

SECTION III

SPECIFIC INSTRUCTIONS

• You are divorced, widowed, or legally separated from
the individual with whom you filed the joint return.

FOREIGN ADDRESS
Enter the information in the following order: city, province or
state, and country. Follow the country’s practice for entering
the postal code. Do not abbreviate the country name.

• You and the individual with whom you filed the joint
return have not been members of the same household
at any time during the 12-month period preceding the
date the election packet is filed.

LINE INSTRUCTIONS
SECTION II
SPOUSAL NOTIFICATION
The Department is required to inform the non-electing
spouse (your spouse or former spouse) of your request for
relief from liability. There are no exceptions even for victims
of spousal abuse or domestic abuse.
The Department will contact the non-electing spouse and
allow him or her to provide information that may assist in
determining your eligibility for relief from joint liability. The
Department will also inform the non-electing spouse of its
preliminary and final determinations regarding your request
for relief. However, to protect your privacy, the Department
will not provide information to the non-electing spouse that
could infringe on your privacy. The Department will not
provide your new name, address, information about your
employer, phone number, or any other information that does
not relate to a determination about your request for relief
from liability.
VICTIM OF DOMESTIC ABUSE
If you have been a victim of domestic abuse and fear that
filing an election for relief from joint liability will result in
retaliation, fill in the oval in Section II. Filling in this oval will
alert the Department to the sensitivity of your situation. It
does not grant you special consideration for purposes of the
Department’s determination regarding your request for relief.
However, evidence of abuses are factors that the
2

PA-8857

REQUESTING SEPARATION OF LIABILITY
Use PA-12507, Innocent Spouse Statement, to explain why
you believe you qualify for separation of liability relief. Show
the total amount of the understatement of tax. For each item
that resulted in an understatement of tax, explain whether
the item is attributable to you, the person listed in Section
II, or both of you. For example, unreported income earned
by the person listed in Section II would be allocated to that
person. See PA-971 for more details.
Exception: If, at the time you signed the joint return, you
knew about any item that resulted in part or all of the
understatement, then your request will not apply to that part
of the understatement.

SECTION IV
UNDERSTATEMENT OF TAX RELIEF
You may be relieved of joint liability for an understatement
of tax and the related interest and penalties if all the
following conditions are met:
1.You filed a joint return which has an understatement of
tax due to an erroneous item of your spouse;
2.You establish that at the time you signed the joint return
you did not know and had no reason to know that there
was an understatement of tax. (If you establish that you
were the victim of domestic abuse prior to the time you
signed your joint return, and that, as a result of the prior
abuse, you did not challenge the treatment of any items
on the return for fear of your spouse’s retaliation, you
www.revenue.pa.gov

can qualify for relief even if you had actual knowledge
of your spouse’s understatement of tax.); and
3.Taking into account all the facts and circumstances, it
would be unfair to hold you liable for the understatement of tax.
ERRONEOUS ITEMS
Any income, deduction, credit, or reported basis is an
erroneous item if it is omitted from or incorrectly reported on
the joint return.
PARTIAL INNOCENT SPOUSE RELIEF
If you knew about any of the erroneous items, but not the
full extent of the item(s), you may be allowed relief for the
part of the understatement you did not know about. Explain
in the PA-12507 you attach to Form PA-8857 how much you
knew about the erroneous item, and the reason(s) you did
not know and had no reason to know the full extent of the
understatement despite your having knowledge or the
erroneous items.
REQUESTING RELIEF BY UNDERSTATEMENT OF TAX
Use PA-12507 to explain why you believe you qualify for
understatement of tax relief. The statement will vary
depending on your circumstances, but should include all of
the following:
• The amount of the understatement of tax for which you
are liable and are seeking relief;

www.revenue.pa.gov

• The amount and detailed description of each erroneous
item, including why you had no reason to know about
the item, or if you did know of the item, the reason you
had only partial knowledge, and the extent to which you
did know about the item; and
• Why you believe it would be unfair to hold you liable for
the understatement of tax.

SECTION V
INCOME ALLOCATION RELIEF
You may qualify for relief by income allocation if you are
jointly liable for an underpayment of tax, and the underpaid
tax is not attributable to income that would have been on
your separate return if you were to have filed a separate
return. In addition, you may qualify for relief by income
allocation if you failed to qualify for relief from joint liability
for an erroneous item through your election for relief from
an understatement of tax or your election for relief by
separation of liability.
REQUESTING RELIEF BY INCOME ALLOCATION
Use PA-12507 to explain why you believe it would be unfair
to hold you liable for the tax instead of the person listed in
Section II. If you are attaching a PA-12507 for separation of
liability or understatement of tax relief, only include any
additional information you believe supports your request for
income allocation relief.

PA-8857

3

Form PA 12510

QUESTIONNAIRE FOR RELIEF FROM JOINT LIABILITY FOR REQUESTING SPOUSE

(10-09)

(Used in conjunction with Form PA 8857, Request for Relief from Joint Liability)

Your Name:

Your Social Security Number:

Purpose for this information
Depending on the nature of your claim for relief for joint liability, we must evaluate many factors including:
•
•
•
•
•

Your marital status;
Whether the items that created the liability are yours;
Whether you believed that your spouse paid, or was going to pay, the tax due that you reported on your return;
Your current financial situation; and
Considering all the facts, is it fair to hold you responsible for the liability?

The Department recognizes that some of the questions below involve sensitive subjects; however, the Department needs this
information to evaluate the circumstances of your case and properly determine whether you qualify for relief.
Instructions
The questionnaire is divided into 5 parts. All parts may not apply to you. Please read the instructions for each part to see if it
applies to you. If so, answer all the questions for that part. If more space is needed, you may attach additional pages.
Attach any documents you have that support your answers.

PART 1 - Complete this part for all requests for relief (understatement of tax, separation of liability or, income allocation relief).
1a. Are you crediting an overpayment to a prior year tax liability or the execution of a lien against your property
requesting a refund for any payment you made individually?
 Yes
 No
1b. Identify the date and amount of these payments. Provide any documentation you may have to prove you made these payments such as correspondence from the Department and copies of the front and back of cancelled checks or money
orders.

2. What is the current marital status between you and the (ex)spouse with whom you filed the joint return(s) for the
year(s) you are requesting relief?







Married and living together
Married, living apart
Legally Separated
Divorced
Widowed

Provide
Provide
Provide
Provide

date
date
date
date

(month,
(month,
(month,
(month,

day,
day,
day,
day,

year)
year)
year)
year)

_____/_____/_____
_____/_____/_____
_____/_____/_____
_____/_____/_____

(Enclose a complete copy of the separation agreement, divorce decree, or death certificate. If you are still married but living apart, provide
documentation to verify the date of your separation, such as copies of your lease agreement or utility bills in your individual name.)

3. Why did you file a joint return(s) instead of your own separate return(s)?

4. What was your involvement in the preparation of the return(s)?

5. Did you review the tax return(s) before signing?
If no, explain why not.

 Yes

Page 1 of 4

 No

Form PA 12510

6. If your (ex)spouse was self employed, did you assist him/her with the business?
If yes, what were your responsibilities?

 Yes

 No

7a. During the year(s) in question, did you have your own separate bank account?
If yes, indicate the type of account(s), the financial institution and account number(s).

 Yes

 No

 Yes

 No

7b. What funds were deposited to the account(s)?

7c. What bills were paid out of the account(s)?

8a. During the year(s) in question, did you and your (ex)spouse have any joint bank accounts?
If yes, indicate the type of account(s), the financial institution and account number(s).

8b. What access did you have to the account(s)?

8c. What funds were deposited to the account(s)?

8d. Who made the deposits?

8e. What bills were paid out of the account(s)?

8f. Who wrote the checks?

8g. Did you review the monthly bank statement?
 Yes  No
8h. Did you balance the checkbook to the bank statement?
 Yes  No
9. Did you pick up and open the household mail?
 Yes  No
10. Identify any periods of separation between you and your (ex)spouse during the year(s) in question.

Form PA 12510

Page 2 of 4

11. If you were abused by your (ex)spouse during the year(s) at issue, please describe the nature and extent of the abuse.
Provide documentation such as police reports, doctor’s statements, or an affidavit from someone aware of the abuse.

12. What was your highest level of education during the year(s) you are requesting relief?
Note any business or tax-related courses you completed by that time.

13. What was your (ex)spouse’s highest level of education during the year(s) you are requesting relief?
Note any business or tax-related courses he or she completed by that time.

14 What business experience did you have during the year(s) you are requesting relief?

15. Have any assets been transferred from your (ex)spouse to you?
If yes, list the assets and the date of transfer. Explain why they were transferred to you.

 Yes

 No

 Yes

 No

16. How was the extra money from the unpaid taxes spent?

17. Explain any other factors you feel should be considered for granting relief.

PART 2
1a. At the time you signed the return(s) did you know there was a balance due?
1b. If no, explain why you did not know.

1c. If yes, explain when and how you thought it would be paid.

2. Describe what funds were available at the time to pay the balance due.

3. At the time you signed the return, did you know about any financial problems you and your (ex)spouse were having
such as a bankruptcy, high credit card debt, or difficulty in paying monthly living expenses?
 Yes
 No
If yes, please describe them.

4. After the return(s) was filed, what efforts were made by you and your (ex)spouse to pay the tax?

Page 3 of 4

Form PA 12510

PART 3
1a. At the time of signing, were you concerned about any item(s) omitted from or reported on the return(s)?
 Yes
 No
1b. If yes, which item(s) did you inquire about and what responses did you get?

1c. At that time, describe how much you knew about each of the incorrect item(s).

2. At that time of signing, if you were not concerned about any item(s), when and how did you first become aware
of the incorrect item(s)?

PART 4
We need the information below to determine whether paying the tax liability would leave you unable to meet basic living
expenses. We base this on your current average monthly household income and expenses. Household includes a spouse or
another person living with you.

Average Monthly Household Income and Expenses
Total number of people in household
Total number of dependents in household
Income

Amount

Expenses

Amount

* Wages

Rent or Mortgage

* Pensions

Food

* Unemployment

Utilities

* Social Security

Telephone

* State, Local and Federal Support

Auto Payments

Alimony

Auto Insurance

Child Support

Auto - Gasoline & Repairs

Self-Employment

Medical - Insurance & Other

Rental Income

Life Insurance

Interest and Dividends

Clothing

Other

Child Care

*Net of withholding for taxes

Public Transportation
Other

PART 5
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 signed:

Daytime phone number:

For Privacy Act Information, please refer to Notice 609 or Form 8857.

Form PA 12510

Page 4 of 4

Best time to call:

REV-488 FO (08-09)

Statement of Financial Condition for Individuals
(If additional space is needed, attach separate sheet)
1. Taxpayer’s name(s) and address(es) (including county)

2. Home phone number

4. Social Security
Number(s)

3. Marital status

a. Taxpayer

b. Spouse

SECTION I – EMPLOYMENT INFORMATION
5. Taxpayer’s employer of business (name and address) or

6. Business phone number

9. (Check appropriate box)
Wage earner
Partner

8. Paydays
10. Spouse’s employer or business (name and address) or

7. Occupation

11. Business phone number

Sole
Proprietor

12. Occupation

14. (Check appropriate box)
Wage earner
Partner

13. Paydays

Sole
Proprietor

SECTION II – PERSONAL INFORMATION
15. Name, address and telephone number of next
of kin or other reference

16. Age and relationship of dependents (exclude
husband and wife) living in your household

17. Number of exemptions
claimed on Form W-4

18. Date of birth

a. Taxpayer

b. Spouse

SECTION III – GENERAL FINANCIAL INFORMATION
19. Latest PA income tax return filed (tax year)

20. Adjusted gross income on return

21. Bank accounts (include Savings and Loans, Credit Unions, IRA and KEOGH accounts, Certificates of Deposit, etc.)
Name of Institutions

Address

Type of Account

Account Number

Balance
$

Total (Enter in Item 28)

$

22. Bank charge cards, lines of credit, etc.
Type of Account or Card

Name and Address of
Financial Institution

Total (Enter in Item 34)

Monthly
Payment

Credit
Limit

Amount
Owed

Credit
Available

$

$

$

$

$

$

$

$

23. Safe deposit boxes rented or accessed (List all locations, box numbers and contents)

24. Real Property (Brief description and type of ownership)

Address (Include county and state)

a.
b.
c.
25. Life Insurance (Name of Company)

Policy Number

Type

Face Value
$

– Page 1 –

Available Loan Value
$

SECTION III – GENERAL FINANCIAL INFORMATION (continued)
26. Additional Information (Court proceedings, bankruptcies, repossessions, recent transfers of assets for less than full value, anticipated increases
in income, condition of health, etc., include information on trusts, estates, retirement plans, etc., on which you are a participant of beneficiary)

SECTION IV – ASSET AND LIABILITY ANALYSIS
(a)
Asset or Liability

(b)
Description

27. Cash

(c)
Current Market
Value

(d)
Liabilities
Balance Due

(e)
Amount of
Monthly Payment

$

28. Bank accounts
29. Stocks, bonds, investments

$

$

$

$

30. Cash or loan value of insurance
31. Vehicles (model, year, license)

a.
b.
c.

32. Real property

a.
b.
c.

33. Other assets

a.
b.
c.

34. Bank revolving credit
35. Other liabilities

(include judgements, notes
and other charge accounts)

a.
b.
c.
d.

36. Federal taxes owed
37. State taxes owed
38. TOTALS

$

– Page 2 –

SECTION V – INCOME AND EXPENSE ANALYSIS
(a) Income

(b) Necessary Living Expenses

47. Rent/House payment

$

48. Groceries

$

49. Allowable installment
Payments

$

40. Wages/Salary (Spouse)

50. Utilities

$

41. Interest - Dividends

51. Transportation

$

52. Insurance

$

43. Rental Income

53. Medical

$

44. Pension (Taxpayer)
Source:

54. Estimated tax payments

$

45. Pension (Spouse)
Source:

55. Other expenses (specify)

$

56. TOTAL

$

57. Net difference (income less

$

Source

39. Wage/Salary (Taxpayer)

Gross

$

Net

$

42. Net Business Income

(from Form REV-484 or REV-488)

46. TOTAL

(federal-state)

$

$

Item 40 should be completed if you are married even if your spouse is not liable for
the tax. This information is necessary in order for the Department of Revenue to
calculate household income and expenses.

necessary living expenses)

CERTIFICATION – Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities and other information is true, correct and complete.
58. Your Signature

59. Spouse, Attorney or Accountant Signature (POA Attached)

– Page 3 –

60. Date