PA-8379 (EO) 02-17

PA-8379
                        INJURED SPOUSE CLAIM AND ALLOCATION
PA Department of Revenue

Are You an Injured Spouse? 
You may be an injured spouse if you file a joint return showing an overpayment of tax and all or part of the 
overpayment attributable to tax payments that you made was, or is expected, to be applied (offset) against your
spouse’s  past-due  Pennsylvania  personal  income  tax,  child/spousal  support  liability(ies),  court-ordered 
obligations, or federal income tax debt.Complete Form PA-8379, if all threeof the following apply and you want
your share of the overpayment shown on the joint return refunded to you.  

1.  You are not liable for the past-due amounts;

2.  You reported income such as wages, taxable interest, etc. on the joint return; and 

3.  You made and reported payments such as Pennsylvania income tax withheld from your wages or 
     estimated tax payments, OR you claimed the TAX BACK/Tax Forgiveness credit on the joint return. 

Do notuse this form if you are requesting PA Innocent Spouse Relief. Instead, file Form PA-8857, Request
for Relief from Joint Liability. 

How Do You File Form PA-8379? 
Mail Form PA-8379 by itself to the department’s Taxpayers’ Rights Advocate’s Office, Lobby, Strawberry Square,
Harrisburg, PA 17128.   Be sureto include copies of all W-2 forms of both spouses and any Forms 1099-R 
showing income tax withheld. The processing of your claim may be delayed if you do not include these copies.
Please allow at least 8 weeks for the department to process your claim.

PART I.                 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. 

START First name, initial, and last name shown first on the return  Social Security Number shown first  If injured Spouse,
                                                                                                        check here
Ü                                                                                                       4
      First name, initial, and last name shown second on the return Social Security Number shown second If injured Spouse,
                                                                                                        check here
                                                                                                        4

      If you are filing Form PA-8379 with your tax return, skip to Line 5.                              YYYY

  2   Enter the tax year for which you are filing this claim (for example, 1999)4

  3 
      Current home address                                                                         City                                              State                                  ZIP code 

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

  5 Check this box only if you are divorced or separated from the spouse with whom 
      you filed the joint return and you want your refund issued in your name only . . . . 

Go to Part II on the reverse side. 

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PA-8379 (EO) 02-17                                                                                                                                        Page 2
P ART II.                   Allocation Between Spouses of Items on Joint Tax Return
                                                       (a)Amount shown (b) Allocated to                                                          (c)Allocated to
                 Allocated Items                       on joint return injured spouse                                                            other spouse 
                                                                       SSN:                                                           SSN: 
7 Income.  Enter  the  separate  income
  that each spouse earned. Allocate joint
  income, such as interest earned on a
  joint bank account, as you determine.
  But  be  sure  to  allocate               all income
  shown on the joint return. 
a Wages . . . . . . . . . . . . . . . . . . . . . . 
b All other income. Identify the type and
  amount.4

8 Allowable deductions.                     Enter  each
  spouse’s separate deductions, such as
  employee business expenses. Allocate
  other deductions as you determine . . 
9 Credits.         Allocate  any  SP  Tax
  Forgiveness credit to the spouse who
  was allocated the dependent’s exemp-
  tion. Allocate business credits based on
  each spouse’s interest in the business.
  Allocate any other credits as you deter-
  mine. . . . . . . . . . . . . . . . . . . . . . .

10Pennsylvania income tax withheld.
  Enter Pennsylvania income tax with-
  held  from  each  spouse’s  income  as
  shown on Forms W-2 and 1099-R.                Be
  sure to attach copies of these
  forms to your tax return, or to
  Form PA-8379 if you are filing it by
  itself.. . . . . . . . . . . . . . . . . . . . . .
11Payments. Allocate  joint  estimated
  tax payments as you determine. . . . . 
Note:The department will figure the amount of any refund due the injured spouse. 

PART III.                                                 Signature
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. 
Keep a copy      Injured spouse’s signature                                            Date                                           MM/DD/YYYY Phone number (Daytime) 
of this form for                            PLEASE SIGN AFTER PRINTING
your records. 
                 Preparer’s                                            Date MM/DD/YYYY Check if                                                  Preparer’s SSN or PTIN 
Paid             signature  PLEASE SIGN AFTER PRINTING                                 self-employed
Preparer’s       Firm’s name (or yours 4                                                                                                         EIN 
Use Only         if self-employed) and
                 address                                                                                                                         ZIP code 
                            4

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