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(EO) 12-20
OFFICIAL USE ONLY
PA-8857 REQUEST FOR RELIEF FROM JOINT LIABILITY
(Relief from Understatement of Tax, Separation
of Liability and Relief by Income Allocation)
Do not file with your tax return. See instructions.
SECTION I REQUESTER INFORMATION
START Name SSN
Ü
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
relief by submitting an election packet. Otherwise check here and go to Section IV below.
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 Date MM/DD/YY
Please sign this form after printing
Preparer’s Signature (self employed ) Date MM/DD/YY Preparer’s SSN or PTIN
Please sign this form after printing
Firm’s Name (or yours if self-employed) 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

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No text to extract.

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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

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                                                   Instructions for Form PA-8857 
PA-8857 IN (EO) 02-20                                                  Request for Relief from Joint Liability

                                                                 your spouse or former spouse should be held liable. You 
        GENERAL INFORMATION
                                                                 must file the packet no later than 2 years after the date the 
You may not claim relief from an understatement of Tax,          Department first attempted to collect the tax from you. Some 
separation of liability or relief by income allocation unless    example of attempts that may start the 2 year period are:   
you filed a joint return with your spouse during the year for    • The mailing of a notice that the Department plans to 
which you are claiming relief.                                   intercept your Federal Income Tax refund. 
Do not file this form if you filed a joint return showing an     • The issuance of a writ of execution.  
overpayment of tax and all or part of the overpayment is 
expected to be applied against your spouse’s past due            The issuance of a billing notice, a preassessment notice, or 
Pennsylvania Income       Tax, child/spousal      support        an assessment notice is not a collection activity. 
liability(ies), court ordered obligations, or federal income tax 
                                                                    You should not file an election packet until the tax for 
debt. Instead, file form PA-8379, Injured Spouse Claim and 
                                                                   which relief is requested may no longer be appealed.  
Allocation, to have your share of the overpayment refunded 
                                                                 Your appeal rights must have expired before you request 
to you. 
                                                                 relief from joint liability.   
  The Department can help you with your request by 
  calling 717-772-9347.                                          WHERE TO FILE 
                                                                 Do not file Form PA 8857 with your tax return or fax it to the 
HOW TO REQUEST RELIEF 
                                                                 Department. Instead, mail it to: 
File an election packet to request relief for an outstanding 
liability from the PA Department of Revenue for the following    PA DEPARTMENT OF REVENUE 
three types of relief:                                           OFFICE OF TAXPAYERS’ RIGHTS ADVOCATE 
                                                                 STRAWBERRY SQUARE LOBBY 
• Understatement of Tax 
                                                                 327 WALNUT ST 
• Separation of Liability                                        HARRISBURG PA  17128 
• Income Allocation 
                                                                               DEFINITIONS
The election packet includes the following forms:                                                                    
• PA-8857, Request for Relief from Joint Liability               UNDERSTATEMENT OF TAX 
• PA-12507, Innocent Spouse Statement                            An understatement of tax is generally the difference 
                                                                 between the total amount of tax that you should have 
• PA-12510, Questionnaire for Spousal Relief from Joint 
                                                                 reported on your return and the amount of tax that you 
Liability for Requesting Spouse 
                                                                 actually reported. For example, you reported total tax of 
• REV-488, Statement of Financial Condition for                  $2,500 on your 2005 return. The Department reviewed your 
Individuals.                                                     2005 return and determined that the total tax is $3,000. You 
You may request relief for more than one tax year in a single    have a $500 understatement of tax.   
election packet.   
                                                                 UNDERPAYMENT OF TAX 
You must fully complete all of the above forms for a valid       An underpayment of tax is the amount of tax you reported 
election packet.                                                 on your return, but you have not paid. For example, your 
ADDITIONAL INFORMATION                                           joint 2008 return shows that you and your spouse owe 
See PA-971, Reliet from Joint Liability (Innocent Spouse         $5,000.  You pay $2,000 with the return.  You have an 
Relief), for more details.  You can get  PA-971 by               underpayment of $3,000. 
downloading from the Department’s home page at                   JOINT AND SEVERAL LIABILITY 
www.revenue.pa.gov or contact the office of Taypayers’ 
                                                                 Joint and several liability applies to all joint returns. This 
Rights Advocate at 717-772-9347. 
                                                                 means that both you and your spouse (or former spouse) 
WHEN TO FILE                                                     are liable for any underpayment of tax plus any 
You should file a complete election packet as soon as you        understatement of tax that may become due later. This is 
become aware of a tax liability for which you believe only       true even if a divorce decree states that your former spouse 

www.revenue.pa.gov                                                                                       PA-8857    1

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will be responsible for any amounts due on previously filed            Department may consider for certain types of relief. You 
joint returns.                                                         should fully explain to the Department your concerns in the 
                                                                       statement that you attach to your election. 
APPEAL RIGHTS 
Review of request for relief for an understatement of tax or           Enter the current name and SSN of your spouse (or former 
for relief by separation of liability.  You may appeal the             spouse) with whom you filed a joint return for the tax year(s) 
Taxpayers’ Rights Advocate’s determination of relief for an            listed. If the name of the person shown on that year’s tax 
understatement of tax due to an erroneous statement and                return(s) is different from the current name, enter it in 
relief by separation of liability by filing a petition with the        parentheses after the current name. For example, enter 
Board of Finance and Revenue within sixty days of the                  “Jane Maple (formerly Jane Oak).” Also enter the current 
mailing date of the notice of final determination.                     address and phone number if you know it. 
Taxpayers’ Rights Advocate fails to act. You may also file a           PO BOX 
petition with the Board of Finance and Revenue requesting              Enter the box number instead of the street address only if 
it to review your request for relief if the Department has not         you do not know the street address. 
provided you a final determination within six months from 
the date you filed a complete election packet.                                   SECTION III
                                                                                                                               
Review of request for relief by income allocation. There is            SEPARATION OF LIABILITY 
no right to appeal the Taxpayers’ Rights Advocate’s denial             You may elect separation of liability relief if you meet one of 
of a request for relief by income allocation. 
                                                                       the following conditions at the time you file the election packet: 

                SPECIFIC INSTRUCTIONS                                  • You are divorced, widowed, or legally separated from 
                                                                       the individual with whom you filed the joint return. 
FOREIGN ADDRESS  
                                                                       • You and the individual with whom you filed the joint 
Enter the information in the following order: city, province or        return have not been members of the same household 
state, and country. Follow the country’s practice for entering         at any time during the 12-month period preceding the 
the postal code. Do not abbreviate the country name.                   date the election packet is filed.   
                                                                       REQUESTING SEPARATION OF LIABILITY 
                LINE INSTRUCTIONS                      
                                                                       Use PA-12507, Innocent Spouse Statement, to explain why 
                SECTION II                                             you believe you qualify for separation of liability relief. Show 
                                                                       the total amount of the understatement of tax. For each item 
SPOUSAL NOTIFICATION                                                   that resulted in an understatement of tax, explain whether 
The Department is required to inform the non-electing                  the item is attributable to you, the person listed in Section 
spouse (your spouse or former spouse) of your request for              II, or both of you. For example, unreported income earned 
relief from liability. There are no exceptions even for victims        by the person listed in Section II would be allocated to that 
of spousal abuse or domestic abuse.                                    person. See PA-971 for more details. 
The Department will contact the non-electing spouse and                Exception: If, at the time you signed the joint return, you 
allow him or her to provide information that may assist in             knew about any item that resulted in part or all of the 
determining your eligibility for relief from joint liability. The      understatement, then your request will not apply to that part 
Department will also inform the non-electing spouse of its             of the understatement. 
preliminary and final determinations regarding your request 
for relief. However, to protect your privacy, the Department                     SECTION IV
                                                                                                                               
will not provide information to the non-electing spouse that 
could infringe on your privacy.  The Department will not               UNDERSTATEMENT OF TAX RELIEF 
provide your new name, address, information about your                 You may be relieved of joint liability for an understatement 
employer, phone number, or any other information that does             of tax and the related interest and penalties if all the 
not relate to a determination about your request for relief            following conditions are met:     
from liability.                                                        1.You filed a joint return which has an understatement of 
VICTIM OF DOMESTIC ABUSE                                               tax due to an erroneous item of your spouse; 
If you have been a victim of domestic abuse and fear that              2.You establish that at the time you signed the joint return 
filing an election for relief from joint liability will result in      you did not know and had no reason to know that there 
retaliation, fill in the oval in Section II. Filling in this oval will was an understatement of tax. (If you establish that you 
alert the Department to the sensitivity of your situation. It          were the victim of domestic abuse prior to the time you 
does not grant you special consideration for purposes of the           signed your joint return, and that, as a result of the prior 
Department’s determination regarding your request for relief.          abuse, you did not challenge the treatment of any items 
However, evidence of abuses are factors that the                       on the return for fear of your spouse’s retaliation, you 

2 PA-8857                                                                                                www.revenue.pa.gov

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can qualify for relief even if you had actual knowledge         • The amount and detailed description of each erroneous 
of your spouse’s understatement of tax.); and                   item, including why you had no reason to know about 
3.Taking into account all the facts and circumstances, it       the item, or if you did know of the item, the reason you 
would be unfair to hold you liable for the under-               had only partial knowledge, and the extent to which you 
statement of tax.                                               did know about the item; and  
                                                                • Why you believe it would be unfair to hold you liable for 
ERRONEOUS ITEMS 
                                                                the understatement of tax. 
Any income, deduction, credit, or reported basis is an 
erroneous item if it is omitted from or incorrectly reported on   SECTION V
the joint return.                                                                                       
                                                                INCOME ALLOCATION RELIEF 
PARTIAL INNOCENT SPOUSE RELIEF 
                                                                You may qualify for relief by income allocation if you are 
If you knew about any of the erroneous items, but not the 
                                                                jointly liable for an underpayment of tax, and the underpaid 
full extent of the item(s), you may be allowed relief for the   tax is not attributable to income that would have been on 
part of the understatement you did not know about. Explain      your separate return if you were to have filed a separate 
in the PA-12507 you attach to Form PA-8857 how much you         return. In addition, you may qualify for relief by income 
knew about the erroneous item, and the reason(s) you did        allocation if you failed to qualify for relief from joint liability 
not know and had no reason to know the full extent of the       for an erroneous item through your election for relief from 
understatement despite your having knowledge or the             an understatement of tax or your election for relief by 
erroneous items.                                                separation of liability. 
REQUESTING RELIEF BY UNDERSTATEMENT OF TAX                      REQUESTING RELIEF BY INCOME ALLOCATION 
Use PA-12507 to explain why you believe you qualify for         Use PA-12507 to explain why you believe it would be unfair 
understatement of tax relief.  The statement will vary          to hold you liable for the tax instead of the person listed in 
depending on your circumstances, but should include all of      Section II. If you are attaching a PA-12507 for separation of 
the following:                                                  liability or understatement of tax relief, only include any 
• The amount of the understatement of tax for which you         additional information you believe supports your request for 
are liable and are seeking relief;                              income allocation relief.

www.revenue.pa.gov                                                                            PA-8857  3

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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 paymentyou made?individually Yes No
1b. Identify the date and amount of these payments. Provide any documentation you may have to prove you made these pay-
ments 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 Provide date (month, day, year) _____/_____/_____
Legally Separated Provide date (month, day, year) _____/_____/_____
Divorced Provide date (month, day, year) _____/_____/_____
Widowed Provide date (month, day, 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? Yes No
If no, explain why not.

Page 1 of 4 Form PA 12510

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6. If your (ex)spouse was self employed, did you assist him/her with the business?                   Yes  No
If yes, what were your responsibilities?

7a. During the year(s) in question, did you have your own separate bank account?                     Yes  No
If yes, indicate the type of account(s), the financial institution and account number(s). 

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?        Yes  No
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

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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? Yes No
If yes, list the assets and the date of transfer. Explain why they were transferred to you.

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? Yes No
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

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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: Best time to call:

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

Form PA 12510                                          Page 4 of 4

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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 3. Marital status

4. Social Security a. Taxpayer b. Spouse
Number(s)
SECTION I – EMPLOYMENT INFORMATION
5. Taxpayer’s employer of business (name and address) or 6. Business phone number 7. Occupation

8. Paydays 9. (Check appropriate box) Sole
Wage earner Partner Proprietor
10. Spouse’s employer or business (name and address) or 11. Business phone number 12. Occupation

13. Paydays 14. (Check appropriate box) Sole
Wage earner Partner Proprietor
SECTION II – PERSONAL INFORMATION
15. Name, address and telephone number of next 16. Age and relationship of dependents (exclude 17. Number of exemptions
of kin or other reference husband and wife) living in your household 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 Monthly Credit Amount Credit
Financial Institution Payment Limit Owed Available
$$$$

Total (Enter in Item 34) $$$$
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 Available Loan Value
$$

– Page 1 –

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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
                                                        (c)           (d)         (e)
             (a)                         (b)
                                                       Current Market Liabilities Amount of
         Asset or Liability           Description
                                                        Value         Balance Due Monthly Payment

27. Cash                                               $

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               a.
(include judgements, notes
and other charge accounts)          b.

                                    c.

                                    d.

36. Federal taxes owed

37. State taxes owed

38. TOTALS                                             $$$

                                         – Page 2 –

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SECTION V – INCOME AND EXPENSE ANALYSIS

(a) Income (b) Necessary Living Expenses

47. Rent/House payment $
Source Gross Net
48. Groceries $

49. Allowable installment
39. Wage/Salary (Taxpayer) $$ Payments $

40. Wages/Salary (Spouse) 50. Utilities $

41. Interest - Dividends 51. Transportation $

42. Net Business Income
52. Insurance $
(from Form REV-484 or REV-488)

43. Rental Income 53. Medical $

44. Pension (Taxpayer) 54. Estimated tax payments $
Source: (federal-state)

45. Pension (Spouse) 55. Other expenses (specify) $
Source:

46. TOTAL $ $ 56. TOTAL $

Item 40 should be completed if you are married even if your spouse is not liable for 57. Net difference (income less $
the tax. This information is necessary in order for the Department of Revenue to necessary living expenses)
calculate household income and expenses.

CERTIFICATION – Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities and other infor-
mation is true, correct and complete.
58. Your Signature 59. Spouse, Attorney or Accountant Signature (POA Attached) 60. Date

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