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                                              STATE OF SOUTH CAROLINA                                                SC8857 
                                              DEPARTMENT OF REVENUE                                                  (Rev. 4/17/18) 
                                                                                                                     3330
    dor.sc.gov REQUEST FOR INNOCENT SPOUSE RELIEF
Was your state refund applied to a debt such as a Hospital Bill, Child Support, Student Loan, etc.?             Yes             No 
If Yes, do not file this form. You need to contact the claimant agency to which the refund was applied.
Your name                                                                                              Social Security Number 

Current mailing address                                             City                                                   State                                           ZIP Code

WHO SHOULD FILE THIS REQUEST?
This request should be filed by a spouse requesting consideration as an innocent spouse who has: 
(1) received a proposed assessment from the Department of Revenue, or  
(2) had a tax refund applied to a delinquent South Carolina tax liability for which an innocent spouse is not liable.

Part I
1  Enter each tax year you want relief. It is important to enter the correct year. For                 Tax Year 1 Tax Year 2                    Tax Year 3
    example, if the state used your 2015 income tax refund to pay a 2013 tax amount you 
    jointly owed, enter tax year 2013, not tax year 2015. 
2  Information about the person with whom you incurred the joint liability. 
Name                                                                                                   Social Security Number 

Current home address (number and street) 

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

Part II
3   Have you been granted innocent spouse relief by the IRS? (Attach verification.)                    Yes                                    No
4   State the reason(s) why you are entitled to this relief.

Note. If you need more room to write your answer for any question, attach more pages. Be sure to write your name and social security 
number on the top of all pages you attach. 

Part III
5    What is the current marital status between you and the person on line 2?  
  
     Married and still living together 
                                       MM      DD      YYYY 
       
     Married and living apart since  
                                       MM      DD      YYYY 
       
     Widowed since                                                                        Attach a photocopy of the death certificate and will (if one exists). 
                                       MM      DD      YYYY 
       
     Legally separated since                                                          Attach a photocopy of your entire separation agreement. 
                                       MM     DD      YYYY 
       
     Divorced since                                                                        Attach a photocopy of your entire divorce decree.  
                                       MM     DD      YYYY 
       
    Note. A divorce decree stating that your former spouse must pay all taxes does not necessarily mean you qualify for relief.

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6   Were you a victim of spousal abuse or domestic violence during any of the tax years you want relief? If the answers are 
not the same for all tax years, explain. 
          Yes. Attach a statement to explain the situation and when it started. Provide photocopies of any documentation, such as police 
          reports, a restraining order, a doctor’s report or letter, or a notarized statement from someone who was aware of the situation. 
            
          No. 

7    Did you sign the return(s)? If the answers are not the same for all tax years, explain. 
          Yes. If you were forced to sign under duress (threat of harm or other form of coercion), attach a statement explaining and 
          verifying that your signature was signed under duress.  
            
          No. If your signature was forged, attach a statement explaining and verifying the forgery of your signature. 

8   When any of the returns were signed, did you have a mental or physical health problem or do you have a mental or 
     physical health problem now? If the answers are not the same for all tax years, explain. 
          Yes. Attach a statement to explain the problem and when it started. Provide photocopies of any documentation, such as medical 
          bills or a doctor’s report or letter. 
            
          No. 

Part IV          Tell us how you were involved with finances and preparing returns for those tax years
9   How were you involved with preparing the returns? Check all that apply and explain, if necessary. If the answers are not the  
     same for all tax years, explain.  
          You filled out or helped fill out the returns. 
          You gathered receipts and cancelled checks. 
          You gave tax documents (such as Forms W-2, 1099, etc.) to the person who prepared the returns. 
          You reviewed the returns before they were signed. 
          You did not review the returns before they were signed. Explain below. 
          Other 

Explain how you were involved 

10 For the years you want relief, how were you involved in the household finances? Check all that apply. If the answers are not 
     the same for all tax years, explain. 
          You knew the person on line 2 had separate accounts. 
          You had joint accounts but you had limited use of them or did not use them. Explain below. 
          You used joint accounts. You made deposits, paid bills, balanced the checkbook, or reviewed the monthly bank statements. 
          You made decisions about how money was spent. For example, you paid bills or made decisions about household purchases. 
          You were not involved in handling money for the household. 
          Other  
            
Explain anything else you want to tell us about your household finances 

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Part V   Tell us the number of people currently in your household.
11  Tell us the number of people currently in your household.               Adults                            Children
12  Tell us your current average monthly income and expenses for your entire household. If family or friends are helping to 
      support you, include the amount of support as gifts under Monthly income. Under Monthly expenses, enter all expenses, 
      including expenses paid with income from gifts. 
              Monthly income                                          Amount            Monthly expenses                                      Amount
                                                                             Federal, state, and local taxes deducted 
Gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        from your paycheck   . . . . . . . . . . . . . . . . . . 
Wages (Gross pay)    . . . . . . . . . . . . . . . . . . . . .               Rent or mortgage . . . . . . . . . . . . . . . . . . . .
Pensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Unemployment      . . . . . . . . . . . . . . . . . . . . . . . .            Telephone . . . . . . . . . . . . . . . . . . . . . . . . . .
Social security   . . . . . . . . . . . . . . . . . . . . . . . . .            
Government assistance, such as housing,                                      Food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
food stamps, grants . . . . . . . . . . . . . . . . . . . . .                Car expenses, payments, insurance, etc. 
Alimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          Medical expenses, including medical 
  . . . . . . . . . . . . . . . . . . . . . . . . . .                        insurance  . . . . . . . . . . . . . . . . . . . . . . . . . .
Child support     . . . . . . . . . . . . . . . . . . . . . . . . .          Life insurance . . . . . . . . . . . . . . . . . . . . . . .
Self-employment business income . . . . . . . . . .                          Clothing  . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rental income . . . . . . . . . . . . . . . . . . . . . . . . .              Child care . . . . . . . . . . . . . . . . . . . . . . . . . . 
Interest and dividends . . . . . . . . . . . . . . . . . . . . .             Public transportation . . . . . . . . . . . . . . . . . . 
Other income, such as disability payments,                                   Other expenses, such as real estate 
gambling winnings, etc.  . . . . . . . . . . . . . . . . . .                 taxes, child support, etc. . . . . . . . . . . . . . . .
List the type below: . . . . . . . . . . . . . . . . . . . . .               List the type below: . . . . . . . . . . . . . . . . . . . 
Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                             Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                                                                               
Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                             Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                                                                               
Type  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                            Type _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
                                                                               
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               Total . . . . . . . . . . . . . . . . . . . . . . . . . . 

13  Please provide any other information you want us to consider in determining whether it would be unfair to hold you liable 
      for the tax. If you need more room, attach more pages. Be sure to write your name and social security number on the top of all 
      pages you attach.  
   
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14   Provide a daytime telephone number. __________________________ 
     The Department may contact you to ask additional questions or receive clarification of the information provided. 
I declare that this return and all attachments are true, correct, and complete. Declaration of preparer (other than 
taxpayer) is based on all information of which preparer has any knowledge. To willfully furnish a false or fraudulent 
statement to the Department is a crime.
Innocent spouse's signature                                            Date         Phone 
                                                                                    ( )
Taxpayer's email address:                      Preparer's email address:

           Preparer's                          Date                    Check if     PTIN or FEIN
           signature                                                   self-employed
Paid 
Preparer's Firm's name (or yours 
Use Only   if self-employed) and 
           address

WHEN  TO FILE?
Do not file until you receive a notice from the SC Department of Revenue.

WHERE TO FILE?
Please mail the completed Innocent Spouse Relief request to: 
  
ATTENTION: INNOCENT SPOUSE RELIEF 
TAXPAYER ADVOCATE SECTION 
P.O. BOX 125 
COLUMBIA SC 29214-0790 
 
GENERAL INSTRUCTIONS 
  
1.  Complete all questions in order for your request to be considered. 
  
2.  Attach a SC2848 Power of Attorney form if you are represented by a third party. 
  
3.  Please use separate page(s) for any additional information. 
  
4.  Keep a copy of this form for your records. 
    
"Claimant agency" means a state agency, board, committee, commission, public institution of higher learning, political 
subdivision, or other governmental entity of any state or the United States. 

Social Security Privacy Act Disclosure 
It is mandatory that you provide your social security number on this tax form. 42 U.S.C 405(c)(2)(C)(i) permits a state to 
use an individual's social security number as means of identification in administration of any tax. SC Regulation 117-201 
mandates that any person required to make a return to the SC Department of Revenue shall provide identifying numbers, 
as prescribed, for securing proper identification. Your social security number is used for identification purposes. 

The Family Privacy Protection Act 
Under the Family Privacy Protection Act, the collection of personal information from citizens by the Department of 
Revenue is limited to the information necessary for the Department to fulfill its statutory duties. In most instances, once 
this information is collected by the Department, it is protected by law from public disclosure. In those situations where 
public disclosure is not prohibited, the Family Privacy Protection Act prevents such information from being used by third 
parties for commercial solicitation purposes. 

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