Indiana Spousal Post-liability Allocation Worksheet

Spousal Post-liability Allocation Worksheet
Form IN-40PA
Schedule

IN-40PA

State Form 51754
(R6 / 6-22)

Indiana Department of Revenue

Indiana Post-liability
Allocation Schedule

Tax Year________________

Are You a Spouse Not Liable for All or Part of a Tax Liability?
You may use this form if:
•
•
•

You have a tax liability reported on a joint return that your are not responsible for;
You have a tax liability reported on a joint return, but you are responsible only for a portion of the liability; or
You have received an assessment from the Indiana Department of Revenue and you are not liable for all or part of the
assessment because the assessment arises from the tax attributable to your spouse

Complete this form to determine the applicable breakdown of income, exemptions and credits of the responsible taxpayer and the
spouse requesting relief. The responsible taxpayer is the taxpayer that is not filing for liability relief.
Required Attachments
You must attach a copy of the following information to this schedule:
1. Your federal income tax return (Form 1040 or 1040-SR) for the year of the claim,
2. All W-2 forms of both spouses and any other forms showing state/county income tax withheld, and
3. A detailed letter explaining the sources of your income and your spouse’s income, deductions, credits, and any other
information relevant to computing the liability of you and your spouse.
4. A copy of the Indiana Return and all schedules for the applicable year(s).
Note: Your claim cannot be processed if you do not submit this required information.
Part 1 - Information About the Joint Tax Return for Which This Claim is Filed
1.

Enter the following information exactly as it is shown on the tax return for which you are filing this claim. The spouse’s name and
Social Security number shown first on that tax return must also be shown first below.

First name, initial, and last name shown first on the return

First name, initial, and last name shown second on the return

2.

Check here if
Spouse Requesting Relief

Social Security number
shown second

Check here if
Spouse Requesting Relief

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Enter Your current home address.

Street Address

3.

Social Security number
shown first

City

Is the address on your joint return different from the address shown above?

State

□

Yes

*24100000000*
24100000000

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No

ZIP Code

Part 2 - Allocation Between Spouses of Items on the Joint Indiana Individual Income Tax Return
(a)
Amount shown on
joint federal and
Indiana tax returns

Allocated Items

(b)
Amount allocated
to you

(c)
Amount allocated to
other spouse

4.	 Income. Enter the separate income that each spouse
earned. Allocate joint income, such as interest earned
on a joint bank account, as you determine. Be sure to
allocate all income shown on the joint tax return.
a.	 Wages
b.	 All other income. Identity the type and amount:
_____________________________________________
_____________________________________________
_____________________________________________
5.	 Adjustments claimed on your federal tax return.
Enter each spouse’s separate adjustments, such as an
IRA deduction. Allocate other adjustments claimed on
your federal return as you determine.
6.	 Indiana Tax Add-Backs. Enter each spouse’s share of
tax add-backs from Schedule 1/B, and identify:
Allocate each add-back
claimed on your Indiana
return as you determine.

code no.
code no.
code no.

7.	 Indiana Deductions. Enter each spouse’s share of
deductions from Schedule 2/C, and identify:
Allocate each deduction
claimed on your Indiana
return as you determine.

code no.
code no.
code no.

8.	 Number of exemptions. Allocate the exemptions
claimed on the joint Indiana return to the spouse who
would have claimed them if separate returns had been
filed. Enter whole numbers only (for example, you cannot
allocate 3 exemptions by giving 1.5 exemptions to each
spouse). Show the division of exemptions by type,
such as 2 exemptions claimed on Indiana return plus 1
additional exemption for certain dependent child.
9.	 Withholding credits. Enter Indiana state and county tax
withheld from each spouse’s income as shown on the
W-2s, 1099-Rs, W-2Gs, etc. Be sure to attach copies of
these forms to this schedule.
10.	 Credits. Allocate any Indiana earned income credit to the
spouse who was allocated the dependent’s exemption.
Allocate all other Indiana credits based on each spouse’s
interest.
11.	 Payments. Allocate joint estimated tax payments as you
determine.
Note: The Indiana Department of Revenue will figure the amount of any modified amount due or refund due to the spouse
	
requesting relief.

*24100000000*
24100000000

Part 3 - Signature Area
Under penalties of perjury, I declare that I have examined this form and any accompanying schedules or 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.
Signature of Spouse				
Phone
Requesting Relief: __________________________________________ 	Date:______________ Number:______________________
Paid Preparer’s Use Only
Preparer’s
Signature: _________________________________________________ 	Date:______________	 Check if self-employed:

Mail your completed claim to:
Indiana Department of Revenue
Returns Processing and Operations
P. O. Box 7207
Indianapolis, IN 46207-7207
Or, Fax it to 317-974-1605.

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