Department of the Treasury - Internal Revenue Service
Form 12451
(Rev. January 2005)               Request for Relocation Expenses Allowance

Submit this form only with an application for certificate of Discharge of Property under IRC section 6325(b)(2)(A)
when relocation expenses are being requested in connection with the sale of a principal residence. Any amount
approved will be deducted from sale proceeds and will not reduce the amount of your tax liability. This allowance
is based upon inability to pay relocation expenses and is subject to limitations. To process your request, please
provide the information requested below. If additional information is needed, you will be contacted.

Section I.                                     Taxpayer Information
1. Taxpayer name                                                                      2. Taxpayer identification
                                                                                          number (EIN or SSN)

3. Address of property being sold (Street, City, State, Zip code)

4. Property is principle residence of taxpayer ("X" appropriate box.)
a. Yes                                         b. No (If "No" is checked, a relocation allowance cannot be approved.)

5. Address of new residence (Street, City State, ZIP code)

6. Amount of relocation expenses requested (Please provide sufficient documentation to support requested expenses.)

7. This allowance may be granted only when inability to pay relocation expenses is determined by United States.
    Please explain your financial circumstances and provide supporting documentation.

Section II.                                    Taxpayer Attestation

                   Under penalties of perjury, I declare that I have examined this application,
                   including all attachments, and to the best of my knowledge and belief, it is
                   true, correct, and complete.

Signature of Taxpayer                                                                 Date

Catalog Number 28667B                          www.irs.gov                           Form 12451 (Rev. 1-2005)