Department of Taxation and Finance

                           Compromise of Spousal Share of Liability                                               DTF-4.2(5/16)
                           On Joint Tax Return
Important things you should know before you file this form:
A taxpayer who has filed a joint income tax return for a taxable year may qualify under New York State Tax Law section 171, 
subdivision eighteenth-d for a compromise of the tax due for that taxable year.
However, the New York State Department of Taxation and Finance offers other joint liability relief programs that may better suit your 
needs. See the tables on page 4. After reviewing the tables, if you believe a compromise of spousal share of liability on joint tax return 
best fits your needs, observe the following:
•  All questions on this form must be answered or your request may be returned to you.
•  Before completing this form, see Terms on page 5 and Instructions on page 6. If you have any questions about how to complete this 
     form, call the Tax Department, Offer in Compromise Unit at (518) 591-5000.

1  According to Tax Law section 171, subdivision eighteenth-d, the following taxpayer submits this offer to the   Date
     Commissioner of Taxation and Finance to compromise a liability for unpaid taxes.                                 /         /

2  Current identifying information
   Your name                                                                   Your social security number        Date of birth (mm/dd/yy)
                                                                                                                      /         /
   Your home address                                                           Telephone numbers 
                                                                               Day (   )                   Evening  (   )

3  Current employment information
   Name of employer                                          Address                                             Telephone number
                                                                                                                 (   ) 

4  Taxpayer representative (if applicable)
   Name of representative                                    Address                                             Telephone number
                                                                                                                 (   )

5  Marital status — At the time of the offer in compromise (OIC), the taxpayer and joint taxpayer (spouse) are (mark an  Xin one):
      Divorced*                           Legally separated                        Living apart and ineligible to file a joint return
      Date                                Date
      * A divorce decree stating that your former spouse must pay all taxes does not necessarily mean that you qualify for relief.
6  List all tax years or liability periods you wish to compromise.

7  Will the collection of the spousal share of the liability from the taxpayer within a reasonable period of time impose substantial        
     hardship? (mark an  Xin one)      Yes                   No
   If Yes, describe the hardship (see page 6 for supporting documents that must be included with your completed Form DTF-4.2):

8  Dependent children or relatives
                          Name                                 Relationship              Social security number               Date of birth

Page 2 of 6  DTF-4.2 (5/16)

9  Enter the names and addresses of all banks or other financial institutions where you have done business during the past
      three years.

                        Name and address                                             Name and address

10  Enter your most recent financial information in the columns below. Enter the fair market value of each asset you own directly 
      or indirectly. Also list your interests in partnerships, S corporations, LLCs, estates, trusts, and other property rights, 
      including contingent interests and remainders.
                                                    Assets                                           Fair market value
  Cash
  Cash surrender value of insurance
  Real estate
  Furniture and fixtures
  Automobiles and trucks
  Recreational vehicles
  Stocks, bonds, and other securities
  Jewelry
  Business equipment
  Individual retirement accounts, 401(k)s, etc.
  Other assets (list below)

  Total assets                                       
                                                                                       $

11  Enter the amount owed on the following applicable liabilities.
                                                    Liabilities                                       Amount
  Mortgage(s)
  Real estate taxes owed
  Judgments
  Federal income tax owed
  Loans from relatives
  Loans from others
  Credit card debt
  Other liabilities (list below)

  Total liabilities                                  
                                                                                       $

12  Real estate (attach copy of indenture, mortgage, and deed for each)
                                                                         Fair market   Balance due    Overdue taxes,
    Address(es) and description(s) of real property             Cost     value         on mortgage    penalties, interest

 Totals                  
                                                    $                  $             $               $

                                                                                                  DTF-4.2 (5/16) Page 3 of 6

13 Automobiles, trucks, boats, planes, and recreational vehicles 
                                                 License                                         Fair market Balance due, if
   Make of vehicle                  Model        plate number         Year          Cost          value      pledged

14 Securities (bonds, stocks, mutual funds, etc.)
                                                                 Number of                       Fair market Balance due, if
                       Name of company                           units              Cost          value          pledged

15 Judgments
                                                                 Amount of     Balance due        Date           Where
                        Name of creditor                         judgment      of judgment       recorded        recorded

16  Current monthly income and expenses – List your current average monthly income and expenses for your entire household.
     Include income from a spouse or anyone who lives with you.

          Income                          Monthly amount                   Expenses               Monthly amount
  Wages (gross pay), tips, etc.                                  Federal, state, and local taxes
                                                                 withheld from your paycheck
 Pensions                                                        Rent or mortgage
 Unemployment                                                    Utilities
 Social security                                                 Telephone
 Government assistance                                           Food
 Alimony received                                                Car expenses, payments,
                                                                 and insurance, etc.
 Child support received                                          Medical expenses, including
                                                                 insurance
 Self-employment                                                 Life insurance
 Rental income                                                   Clothing
 Interest, dividends, capital gains                              Public transportation
 Partnerships, LLCs, and                                         Child care expenses 
 S Corporations 
 Other income (such as                                           Other expenses (such as real
 disability payments)                                            estate taxes and child support)
 List:                                                           List:

  Total                                                          Total 
                                    $                                                           $

17 Enter the number of people in your household.         Adults                  Children under 21

Page 4 of 6  DTF-4.2 (5/16)

For tax years 1999 and after: Types of relief from joint liability available under Tax Law section 654

         Factors           Rules for innocent spouse relief         Rules for separation of liability       Rules for equitable relief

 Type of liability    You must have filed a joint return that       You must have filed a joint return that You must have filed a joint return that 
                      has an understatement of tax due to           has an understatement of tax due,       has either an understatement or an 
                      an erroneous item of your spouse.             at least in part, to an item of your    underpayment of tax.
                                                                    spouse.

 Marital Status       May be considered in determining              You must be no longer married (or       May be considered in determining 
                      whether to grant relief.                      your spouse is deceased), legally       whether to grant relief.
                                                                    separated, or have not lived with 
                                                                    your spouse in the same residence 
                                                                    for an entire year before you file for 
                                                                    relief.
 Knowledge            You must establish that at the                If the Tax Department establishes       May be considered as a factor for 
                      time you signed the joint return              that you actually knew of the item      relief.
                      you did not know, and had no                  giving rise to the understatement, 
                      reason to know, that there was an             then you are not entitled to relief to 
                      understatement of tax or the extent           the extent of the actual knowledge.
                      of the understatement.

 Other qualifications None.                                         None.                                   You do not qualify for innocent 
                                                                                                            spouse relief or separation of liability.

 Unfairness           It must be unfair to hold you liable          Not considered as a factor for relief.  It must be unfair to hold you liable for 
                      for the understatement of tax                                                         the underpayment or understatement 
                      taking into account all the facts and                                                 of tax taking into account all the facts 
                      circumstances.                                                                        and circumstances.

 Refunds              Your request can generate a refund.           Your request cannot generate a          Your request can generate a refund 
                                                                    refund.                                 under certain circumstances.

 To apply                                              File Form IT-285 with supporting documentation.

For tax years prior to 1999: Rules for innocent spouse relief under former Tax Law section 651(b)(5)
 Type of liability           You must have filed a joint return that has a substantial understatement of tax (an amount over $100) due to a 
                             grossly erroneous item of your spouse. Relief under section 651(b)(5) is not available for tax years beginning 
                             on or after January 1, 1999.

 Marital status              Not considered as a factor for relief.

 Knowledge                   You must establish that at the time you signed the joint return you did not know, and had no reason to know, 
                             that there was a substantial understatement of tax.

 Other qualifications        If a substantial understatement is attributable to a New York deduction, exemption, credit, or property basis 
                             for which there is no basis in fact or law, the tax liability must exceed a specified percentage of the innocent 
                             spouse’s New York adjusted gross income for the most recent taxable year ending before the date the 
                             deficiency is mailed. This requirement shall not apply to a substantial understatement attributable to an 
                             omission from New York adjusted gross income.

 Unfairness                  It must be unfair to hold you liable for the substantial understatement of tax taking into account all the facts and 
                             circumstances

 Refunds                     Your request can generate a refund.

 To apply                    File a statement with supporting documentation.

For detailed information, see NYS Publication 89, Innocent Spouse Relief (And Separation of Liability and  Equitable Relief), (at www.nystax.gov ).
For specific details of the offer process, see NYS Publication 220, Offer in Compromise Program.

                                                                                        DTF-4.2 (5/16) Page 5 of 6

                                                         Terms
1. In making this offer, and as a part of consideration, it is agreed that the Commissioner of Taxation and Finance shall 
 keep all payments, sums collected, refund offsets, and other credits made to the liabilities for the periods covered by 
 this offer.
2. It is agreed that upon notice to the taxpayer of the acceptance of this offer, the taxpayer shall have no right to contest in 
 court, or otherwise, the amount of the liability sought to be compromised. No liability will be compromised nor will any 
 warrant be amended until all obligations of this taxpayer under the compromise agreement are completely performed 
 and satisfied. In the event of a default by the taxpayer on the compromise agreement, it is agreed that the Tax 
 Department may disregard the offer and immediately, without notice, proceed to collect the balance of any warrant(s) 
 representing the original liability.
3. It is understood that this offer will be considered and acted upon in due course, and that it does not relieve this taxpayer 
 from the liability sought to be compromised unless and until the offer is accepted in writing by the Commissioner and 
 there has been full compliance with the terms of the offer.
4. This taxpayer waives the benefit of any statute of limitations applicable to the collection of the liability sought to 
 be compromised, and agrees to the suspension of the running of the statutory period of limitations on collection 
 for the period during which this offer is pending, and for one year thereafter. For these purposes, the offer shall be 
 deemed pending from the date of acceptance of the waiver of the statutory period of limitations by the authorized 
 Tax Department official until the date on which the offer is formally accepted, rejected, or withdrawn in writing.

                                         Statement

I declare that I have examined the information given in this statement and, to the best of my knowledge and belief, 
it is true, correct, and complete. This statement is made with the knowledge that a willfully false representation is a 
misdemeanor punishable under section 210.45 of the Penal Law of New York State.

 Date of statement                                            Signature of taxpayer

 Signature of paid preparer (if any)                          ID# of preparer

                                     For office use only (make no marks below this line)
            NYS TAX DEPARTMENT                                We received your Form DTF-4.2, Compromise of 
            CED OFFER IN COMPROMISE UNIT                      Spousal Share of Liability on Joint Tax Return. Your 
            W A HARRIMAN CAMPUS
            ALBANY NY 12227-5100                              case will be assigned to a reviewer who will contact 
                                                              you. 
                                                              If you have any questions, please contact the Offer in 
                                                              Compromise Unit at (518) 591-5000.

                                                                                                Date office received

Page 6 of 6  DTF-4.2 (5/16)
                                                           Instructions
Basis for compromise                                             If your offer is accepted and all terms of the offer are satisfied 
A taxpayer who has filed a joint income tax return for a tax     (that is, your share of the liability is paid in full), the Tax 
year may qualify under New York State Tax Law section 171,       Department will amend the appropriate warrant(s). Interest 
subdivision eighteenth-d for a compromise of some or all of      will also be due at the rates established under the Tax Law 
any tax due for that tax year. The following conditions must     on any deferred portion of the offer from the date of notice of 
be met:                                                          acceptance until it is paid in full.
1.  At the time of the compromise offer, the taxpayer and        Terms on page 5 include: 1) a waiver of refunds; and 2) a 
  spouse are:                                                    waiver of the right to contest the liability after the offer is 
  a)  divorced,                                                  accepted. Your submission of this form is an acceptance of 
                                                                 these provisions.
  b)  legally separated, or
  c)  living apart and ineligible to file a joint return;
        and                                                      Specific instructions
                                                                 Attach additional sheets of paper if you need more space to 
2.  The taxpayer is able to demonstrate that collection of the   answer a question. Identify each sheet by writing your name 
  spousal share of the liability from the taxpayer cannot be     and social security number at the top of the page and the 
  accomplished within a reasonable period of time without        number of the question you are answering.
  imposing substantial economic hardship on the taxpayer. 
  Substantial economic hardship does not require the             Complete all areas, for example:
  taxpayer’s bankruptcy or insolvency.
                                                                 Item 1 – Date the first page of Form DTF-4.2 in the space 
You must also be in compliance with all payment and filing       provided. This date is important for identification and 
requirements for periods not included in the offer. This         reference purposes.
includes estimated tax payments and tax deposits.
                                                                 Item 7 – List the facts and reasons (hardship) that are 
The Tax Department may also require proof of your income         grounds for acceptance of the offer.
during the period(s) for which you seek compromise. Once 
this information is obtained from you and/or our records, your   Signature – Sign and date the Statement on page 5.
share, if any, of the tax liability can be calculated by the Tax 
Department’s Audit Division as follows:                          Submitting Form DTF-4.2
                                                                 After answering all questions, read the Terms on page 5. 
 compromised spouse’s tax                                        You must also attach a copy of the following supporting 
  total recalculated tax for ×  balance on assessment   =amount  documents:
        both taxpayers          as of application date     due
                                                                 1.  proof of marital status - divorce decree, separation papers, 
You will be notified of the results.                             or other;
Submission of an offer does not automatically suspend            2.  your current pay stub or other proof(s) of income;
collection of any warrant. If there is any indication that       3.  Social security lifetime wage earnings statement, if 
the filing of the offer is solely for the purpose of delaying    available;
collection of the tax, the Tax Department will continue          4.  your most recent federal income tax return with all 
collection efforts.                                              attachments and schedules; and
Interest and penalties will continue to accrue on the liability  5.  Form POA-1, Power of Attorney, if you are retaining a 
while your offer is under consideration. Interest rates are      representative.
computed quarterly and may change.
                                                                 These instructions are intended only as an overview of the 
                                                                 offer process and a guide in preparing Form DTF-4.2.