Form 12508 
(Rev. July 2013)           Questionnaire for Non-Requesting Spouse

We recognize that some of these questions involve sensitive subjects. However, we need this information to evaluate the 
circumstances of the claim and properly determine whether relief should be given. If this form is not completed and 
returned, the claim will be considered based on the information available to us. 
                                                                                   Questions?   
                                                                                   Call the IRS at 1-855-851-2009. 
Part I  Tell us about yourself 
1.  Your Current Name                                                            Your Social Security Number 

     Your Current Home Address (number & street)                                 Apt. No.   County 

     City, town or post office box, state and ZIP code                           Daytime phone number (between 6 a.m. 
                                                                                 and 5 p.m. Eastern Time)
                                                                                 (        ) 
2.  What is the current status between you and your spouse for the years that relief was requested? (On this form we refer 
     to your spouse for the years that relief was requested as that individual.) 
        Married and living together 

        Married living apart since 
                                    MM  /  DD  /   YYYY 
        Legally separated since 
                                    MM  /  DD  /   YYYY 
        Divorced since 
                                    MM  /  DD  /   YYYY 
        Widowed since 
                                    MM  /  DD  /   YYYY 
     Note: A divorce decree stating you must pay all taxes does not necessarily mean that individual will qualify for relief. 
Part II Tell us about filing the returns and your financial situation for the years listed on the letter. If the  
        information is not the same for all tax years, please explain. 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. 
3.  How were both of you involved with preparing the returns during those tax years? Check all that apply and explain,  if 
     necessary. If the answers are not the same for all the years, explain. 
     You  That Individual 
                       Prepared or helped prepare the returns. 
                       Gathered receipts and canceled checks. 
                       Gave tax documents (such as W-2s, 1099s, etc.) to the person who prepared the returns. 
                       Asked the person who prepared the returns to explain any items or amounts. 
                       Reviewed the returns before filing them. 
                       Did not review the returns before filing them. 
                           Was not involved with preparing the return.
                       Other 
     Explain, if necessary 

Form 12508 (Rev. 7-2013)  Catalog Number 28730P www.irs.gov    Page 1 of 3       Department of the Treasury – Internal Revenue Service 

4.  When you filed the returns, were any amounts owed to the IRS for those years? 
     Yes. Explain how the amounts owed were to be paid. 

     No 
5.  When that individual signed/filed any of the returns, was he/she aware of any financial problems you were having (for 
     example, bankruptcy or bills you could not pay)? 
     Yes. Explain 

     No 
     Do not know 
6.  For those years, what kinds of accounts did you have? Check all that apply. Explain if the answers are not the same 
     for all the years. 
     Joint Separate
                        Checking or money market
                        Savings or certificate of deposit
     How did that individual use those accounts? Check all that apply. 
     Joint Separate
                        Made deposits
                        Reviewed bank statements or balanced the checkbook
                        Paid bills
                        Knew how much money was in the account
                        Made withdrawals from the account
                        Did not know about the account
                        Did not use the account
                        Was not involved in handling money for the household
     Explain, if necessary 

7.  Did you ever transfer assets to that individual? (Did you put something of value, such as real estate or stocks, in that  
     individual's name rather than in your own name?) 
     Yes. List the assets and the dates they were transferred. Explain why the assets were transferred. 

     No 
8.  During those tax years, were you self employed? 
     Yes. Explain how that individual was involved in your business. 

     No 

Form 12508 (Rev. 7-2013)  Catalog Number 28730P www.irs.gov Page 2 of 3 Department of the Treasury – Internal Revenue Service 

9.  If the tax year(s) in question were audited, what items, if any, changed? Were the changed items yours or that  
     individual’s? (For example, unreported income, disallowed deductions, unclaimed credits) 

10.  If the audit results changed your business income or deductions on your tax return, did that individual help you in the 
     business? If so how? If not, did that individual know about your business affairs? Explain. 

11.  If the items changed by the audit were yours, did that individual benefit from them? (Example, unreported income  
     paid for a family vacation, car, jewelry, etc.) Explain. 

12.  Do you have any other information you want us to consider? 

SIGN      Under penalties of perjury, I declare that I have examined this statement and to the best of my knowledge it  
HERE      is true, correct, and complete. 

Signature                                                     Date 

Keep a copy for your records. Return the original signed form and any attachments in the enclosed envelope or you may 
fax the signed form and attachments to 1-855-233-8558.

Form 12508 (Rev. 7-2013)  Catalog Number 28730P www.irs.gov   Page 3 of 3 Department of the Treasury – Internal Revenue Service