FORM 4b REQUESTING INNOCENT SPOUSE STATUS
TODAY'S DATE:
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AM/PM Option
APPLICANT'S NAME:
Spouse's name:
DO YOU GIVE CONSENT TO COMMUNICATE WITH SPOUSE?
Not applicable - I have no spouse or former spouse
I consent to Mr. King discussing my case with my current spouse
I consent to Mr.King discussing my case with my ex-spouse
I consent to Mr.King discussing my case with both my ex-spouse and my current spouse
I do NOT consent to Mr. King discussing my case with my ex-spouse or current spouse
Not sure - must talk with Mr. King about this before he talks with my ex- or current spouse
WHO ELSE DO YOU CONSENT TO MR.KING DISCUSSING YOUR CASE WITH?
Current or past tax professional
Relative
The IRS
The state taxing agency or officer
My minister
My attorney
I WANT TO APPLY FOR SOME VERSION OF INNOCENT SPOUSE TO AVOID HAVING TO PAY CERTAIN BACK TAXES:
YES
NO
NO SURE
IF NOT SURE PLEASE EXPLAIN:
Do you expect your spouse to object to your seeking innocent spouse status?
No
Yes
No sure
APPLICANT'S CURRENT STATE OF RESIDENCE:
IF DIFFERENT FROM CURRENT STATE - APPLICANT'S STATE WHEN TAXES WERE INCURRED AND NOT PAID:
APPLICANT'S BEST PHONE NUMBER:
APPLICANT'S EMAIL ADDRESS
example@example.com
MY PROFESSIONAL STATUS IS:
NOT APPLICABLE
DEBTOR'S BANKRUPTCY ATTORNEY
CREDITOR'S OR TRUSTEE'S BANKRUPTCY ATTORNEY
TAX ATTORNEY
OTHER CATEGORY OF ATTORNEY
PARALEGAL OR LEGAL ASSISTANT
LAW FIRM OFFICE MANAGER OR OTHER OFFICE STATUS
BANKRUPTCY TRUSTEE
BANKRUPTCY JUDGE
BANKRUPTCY COURT CLERK
LAW LIBRARIAN
LAW FIRM MARKETER
ACADEMIC / INSTRUCTOR
AUTHOR / EDITOR
OPERATE A WEB SERVICE FOR BANKRUPTCY PROFESSIONALS
OFFICER OR OWNER OF A PROFESSIONAL BANKRUPTCY ORGANIZATION
LAW STUDENT
SOFTWARE DEVELOPER
OTHER VENDOR OF BANKRUPTCY PRODUCTS OR SERVICES
Current marital status:
Married and living together
Married but separated
Married living together divorce in progress
Other
Marital status during taxable years
Married and living together
Married but separated
Married living together - divorce in progress
Other
WHAT TAXING AGENCIES ARE CLAIMING YOU OWE TAXES?
Internal Revenue Service
State
County
Other
If other agency please explain:
DO YOU FEEL OR BELIEVE YOU SHOULD NOT BE LIABLE FOR SOME OR ALL OF THE TAXES?
YES - I SHOULDN'T BE LIABLE FOR ANY OF THE TAXES
YES - I SHOULDN'T BE LIABLE FOR SOME OF THE TAXES
NOT SURE
MAYBE
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION?
Did not complete high school
High school
Vocational school
Community college
College degree
Master's degree
Ph.D.
Other
What was your major?
Describe:
Past or current experience with financial, banking, or employment in similar fields:
None
Some
Substantial
Describe:
Current or past involvement in a business:
No business involvement
Yes - see checked below
Business owner
CEO or management
Responsible for business tax payments
Responsible for filing business tax returns
Accountant for business
Other business experience
DESCRIBE Business experience (if any)
During years taxes were owed - what was your involvement with your joint tax returns?
Co-signed but left it all up to spouse to prepare and file
Did not examine the tax returns other than signing them
Did not prepare or file any of the returns
Prepared or filed some of the returns
Other involvement with some or all the returns
If some involvement other than simply signing - describe:
During the years taxes were not paid ...
The other spouse interfered with your desire to review the returns
The other spouse abused you mentally
The other spouse kept financial records from you
The other spouse abused you physically
The other spouse lied to you about information on the returns
You were separated when you signed the returns
None of the above
Please explain:
If abused mentally - did you engage a psychologist for therapy?
Yes
No
If abused physically - did you file a police report?
Yes
No
Were you aware that ...
I had no knowledge of what went into one or more returns
Some income was not reported
Some business expenses were exaggerated
Some other deductions were exaggerated
There was other false income or deductions
Other things that were untruthful or incorrect
If any were selected - please explain
Did you benefit personally from taxes not being paid in full?
Not that I know of
Yes = see √ below
Took expensive vacations
Frequently went to expensive restaurants
Purchased expensive jewelry
Purchased one or more expensive vehicles
Purchased a house
Contributed money to joint retirement accounts
Paid children's college tuition or other college expenses
Other unnecessary expenses or benefits
Had a maid, tutor, or similar helper
We installed or added landscaping
We supported one or more children - rent - car - etc.
I had elective plastic surgery
My spouse or I gambled substantial sums
Please explain the nature and amount of one or more benefit items:
Did you notice any changes in your family finances or spending?
Yes
No
Describe changes in your financial circumstances
During years taxes are due - Did you have a separate bank account?
Yes - all years
Yes - some years
No
Briefly explain why you think you should not be stuck some or any of the taxes:
COPY LETTERS AT RIGHT INTO BOX BELOW AND HIT "SUBMIT"
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Submit to Mr. King
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