KGTax.com - Injured Spouse Form

Injured Spouse and Claim Allocation

Please fill out this form if you feel you qualify for Injured Spouse Protection.
The information will be securely sent to one of the CPAs who will contact you.
If you don't wish to use the internet, you may view the form here, print it out and fax the filled out form to 1-435-752-0277

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.

First name, initial and last name:

Social Security No.:

If Injured Spouse,Check here:

First name, initial and last name:

Social Security No.:

If Injured Spouse,Check here:

Enter your e-mail address:

Enter your phone number:

*This is so our CPAs can contact you

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

3. Current home address:

City:

State:

Zip:

4. Is the address on your joint return different from the address shown above?:

YesNo

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.:

6. Was your main home in a community property state (Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin) at any time During the year entered on line 2?:

YesNo

If "yes", which community property state(s)?

*Note: Overpayments involving community property states will be allocated by the IRS according to state law.

Part II. Allocation Between Spouses of Items on the Joint Tax Return Allocated Items

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) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

Wages

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

All other income. Identify the type and amount

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

8. Adjustments to income. Enter each spouse's separate adjustments, such as an IRA deduction. Allocate other adjustments as you determine.

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

9. Standard deduction. If you itemized your deductions, go to line 10. Otherwise, enter in both columns (b) and (c) ½ of the amount shown in column (a) and go to line 11

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

10. Itemized deductions. Enter each spouse's separate deductions, such as employee business expenses. Allocate other deductions as you determine

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

11. Number of exemptions. Allocate the exemptions claimed on the joint return to the spouse who would have claimed them if separate returns had been filed. Enter whole numbers only (for example, you cannot allocate 3 exemptions by giving 1.5 exemptions to each spouse)

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

12. Credits. Allocate any child tax credit, child and dependent care credit, and additional child tax credit to the spouse who was allocated the dependent's exemption. Do not include any earned income credit here; the IRS will allocate it based on each spouse's income. Allocate business credits based on each spouse's interest in the business.Allocate any other credits as you determine.

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

13. Other Taxes. Allocate self-employment tax to the spouse who earned the self-employment income. Allocate any alternative minimum tax as you determine.

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

14. Federal Income Tax Withheld. Enter Federal income tax withheld 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 8379 if you are filing it by itself.(Also, include on this line any excess social security and RRTA tax withheld)

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

15. Payments. Allocate joint estimated tax payments as you determine. Note: The IRS will figure the amount of any refund due the injured Spouse.

(a) Amount shown on joint return:

(b) Allocated to injured spouse:

(c) Allocated to other spouse:

Additional Comments:

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