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Form 5495 (Rev. 12-2008) Page 2
Information and Instructions Privacy Act and Paperwork Reduction Act Notice.
We ask for the information on this form to carry out the
General Information Internal Revenue laws of the United States. We collect
Ordinarily, the IRS has 3 years after an income tax, gift this information under the authority of Internal Revenue
tax, or estate tax return has been filed to assess tax and Code sections 2204 and 6905. We need it to ensure that
demand payment of any deficiency. The executor you are complying with these laws and to allow us to
representing a decedent’s estate or a fiduciary of a figure and collect the right amount of tax. This
decedent’s trust may request a discharge from personal information is needed to determine eligibility for the
liability for the decedent’s income, gift, and estate taxes. requested discharge from personal liability. You are not
Nine months, or 6 months in the case of a fiduciary’s required to request discharge from personal liability;
request, after the IRS’s receipt of the request for however, if you do so you are required to provide the
discharge or the earlier payment of any amount information requested on this form. Failure to provide the
determined by the IRS to be owed, the executor or information may delay or prevent processing your
fiduciary will be discharged from personal liability for any request; providing false information may subject you to
deficiency in such tax thereafter found to be due. In penalties. Section 6109 requires you to provide the
certain instances where the date for payment of the requested taxpayer identification numbers.
estate tax has been extended, the IRS may require a You are not required to provide the information
bond as a condition for discharge. requested on a form that is subject to the Paperwork
An executor means the executor or administrator of a Reduction Act unless the form displays a valid OMB
decedent, who was appointed, qualified, and acting control number. Books or records relating to a form or its
within the United States. instructions must be retained as long as their contents
may become material in the administration of any Internal
When To File Revenue law. Generally, tax returns and return
Do not file Form 5495 requesting a discharge from information are confidential, as required by section 6103.
income or gift tax liability until after you file the tax returns However, section 6103 allows or requires the Internal
listed on the front of this form. If you are requesting a Revenue Service to disclose or give such information to
discharge from personal liability for the estate tax, you the Department of Justice for civil and criminal litigation;
may attach this form to Form 706, United States Estate to cities, states, the District of Columbia, and U.S.
(and Generation-Skipping Transfer) Tax Return, or you commonwealths and possessions to administer their tax
may file this form any time during the 3-year period laws; and to other countries under a tax treaty. We may
following the date the Form 706 is filed. You must submit also disclose this information to federal and state
a separate request for discharge from personal liability for agencies to enforce federal nontax criminal laws, or to
any tax returns filed after this Form 5495. federal law enforcement and intelligence agencies to
combat terrorism.
Where To File The time needed to complete and file this form and
Send your request to the Internal Revenue Service related schedules will vary depending on individual
Center where you filed the returns listed on the front of circumstances. The estimated average times are:
this form. If you are requesting taxes reported on multiple Recordkeeping . . . . . . . . . . 5 hr., 30 min.
returns filed at different Service Centers, you must mail
separate Forms 5495 to each Service Center to receive a Learning about the law
discharge from liability for each type of tax. If an estate or the form . . . . . . . . . . . 1 hr., 30 min.
tax return was filed, file Form 5495 for all taxes at the Preparing the form . . . . . . . . 4 hr., 27 min.
address where the estate tax return was filed. Copying, assembling, and
What To File sending the form to the IRS . . . . . . . 48 min.
This Form 5495 provides spaces for all information If you have comments concerning the accuracy of
required to process a request for discharge from these time estimates or suggestions for making this form
personal liability under IRC section 2204 or 6905. Attach simpler, we would be happy to hear from you. You can
to your request the information and documentation write to the Internal Revenue Service, Tax Products
requested on Form 5495. If you are submitting this Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111
request with your estate tax return, you will not be Constitution Ave. NW, IR-6526, Washington, DC 20224.
required to provide an additional copy. If, however, this Do not send the tax form to this address. Instead, see
form is filed after Form 706, then a copy of pages 1–3 and Where To File.
Schedules A through I of Form 706 must be attached. If
you are a fiduciary requesting discharge from personal
liability under section 2204, check the “Other” box and
include a copy of the trust instrument(s), a list of assets
transferred from this decedent to the trust, and any other
relevant information. If you prefer to use your own
format, your written request must list the same
information as requested on this form and include the
applicable attachments.
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