Schedule                       Indiana Department of Revenue
     IN-40PA                        Indiana Post-liability
     State Form 51754
     (R5 / 9-21)                    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                Social Security number               Check here if 
                                                                                    shown first                  Spouse Requesting Relief

                                                                                                                         □
First name, initial, and last name shown second on the return               Social Security number               Check here if 
                                                                                  shown second                   Spouse Requesting Relief

                                                                                                                         □

2.  Enter Your current home address.
Street Address                                               City                                          State ZIP Code

3. Is the address on your joint return different from the address shown above?       Yes     No
                                                                                  □        □

                                    *24100000000*
                                                             24100000000

Part 2 - Allocation Between Spouses of Items on the Joint Indiana Individual Income Tax Return

                                                                       (a)              (b)          (c)
                                                                Amount shown on     Amount allocated Amount allocated to 
                                                                joint federal and       to you       other spouse
 Allocated Items                                                Indiana tax returns
 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       code no.              
     claimed on your Indiana      code no.              
     return as you determine. 
                                  code no.   

 7.  Indiana Deductions. Enter each spouse’s share of 
     deductions from Schedule 2/C, and identify:

     Allocate each deduction      code no.              
     claimed on your Indiana 
     return as you determine.     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 317-615-2697.