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Rev. 5/99
Form 84 Massachusetts
Application for Relief Department of
Revenue
from Joint Income Tax Liability

Read the instructions before completing this form to be sure you are eligible to file. Please print or type. Names should appear as they did on
the joint return for the tax year in question.
Tax year for which relief is being requested

First name and initial Last name Social Security number Telephone number

Address (including apartment number) City/Town/Post Office StateZip

Spouse’s first name and initial* Last name Social Security number

*You must have filed a joint return in order to file an Application for Relief

Questionnaire
You must answer all questions. If you answer “Yes” to any question, attach a separate statement explaining your response.
1 Have you applied for relief from federal tax liability as an innocent spouse? Yes No.
If yes, attach copies of the federal request for relief (including any supporting or related documentation), your applicable federal tax
return(s) and the federal determination, if any.
2 Has a Notice of Intention to Assess (NIA) been issued for the tax year for which you are requesting relief? Yes No.
If yes, attach a copy of the NIA. You may request a conference within 30 days after the issuance date of the NIA. If so, attach this form
to your written request for a conference.
3 Has a Notice of Assessment (NOA) been issued for the tax year for which you are requesting relief? YesNo.
If yes, attach a copy of the NOA and this application to Form CA-6, Application for Abatement. Complete all items on Form CA-6,
except for line 9. In line 9 write “see attached Form 84.” You may also request a hearing at this time by so indicating on Form CA-6
or with a separate written request.
4 Indicate the reason and amount of your application.
Relief from joint income tax liability attributable to items omitted from gross income.
$Amount of relief sought (excluding penalties and interest)
Relief from joint income tax liability attributable to a claim or claims of deduction, exemption, credit or basis.
$Amount of relief sought (excluding penalties and interest)
Describe below the facts and circumstances demonstrating that you qualify for relief from liability for a substantial understatement of tax
on a joint return under MGL Ch. 62C, sec. 84. Attach any exhibits substantiating your claim. Use additional paper if necessary.

Pursuant to MGL Ch. 62C, sec. 84, the applicant named herein requests relief from joint income tax liability as an innocent spouse. Under
penalties of perjury, I declare that I have examined this form and any accompanying statements and documents and to the best of my knowl-
edge and belief the facts and statements as represented therein are true, correct and complete. I understand that if relief is granted itwill
apply only to the extent specified in the Commissioner’s determination and that I will remain jointly and severally liable for any amounts
where relief is not provided. Declaration of preparer (other than taxpayer) is based on all information of which he/she has knowledge.
Applicant’s signature Date
¨
Preparer’s signature and attestation. I attest that I prepared this Form 84 and that I personally know/do not know(strike out one) that the statements
contained in this Form 84 are true and correct.
Preparer’s signature (Attach Form M-2848, Power of Attorney, if representing taxpayer)Preparer’s title Date
¨

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Form 84 Instructions

General Information the federal determination, and the federal tax return. Applicants
The Department of Revenue is authorized to grant relief from should also submit any documents or exhibits substantiating
a joint income tax liability under certain conditions. Relief can bethis application. The filing of this form will not stay the collection
granted where a taxpayer and a spouse file a joint income tax of tax unless or until this application is approved. If the applica-
return reporting a substantial understatement of tax attributable tion is approved, a refund of any resulting overpayment of tax
to grossly erroneous items of one spouse if (1) the spouse will be made to the applicant.
requesting relief establishes that he or she did not know, and Application Prior to Assessment
had no reason to know, that there was such a substantial under-
If a taxpayer has received a Notice of Intention to Assess (NIA),
statement; and (2) taking into account all facts and circum-
this application must be received within 30 days following the
stances of a case, it would be inequitable to hold the applicant
issuance of the NIA. The applicant is entitled to a conference
liable for the deficiency.
if one is requested within this 30-day period. If a conference is
For further information refer to Regulation 830 CMR 62C.84.1 requested, this application must be attached to the written
Spousal Relief From Joint Income Tax Liability. This regulation request. Mail the completed Form 84, the NIA and all attach-
is available by calling the Rulings and Regulations Bureau at ments to the return address as shown on the NIA.
(617) 626-3250.
Application After Assessment
Substantial Understatement If a taxpayer has received a Notice of Assessment (NOA), this
To be considered substantial, the understated tax, excluding any application must be made by filing an Application for Abatement
interest and penalties, must exceed $200 where due to an item (Form CA-6). The applicant must attach this application to Form
omitted from gross income; or exceed $500 where due to a claim CA-6 and enter in Item 9 of Form CA-6, “see attached Form 84.”
or claims of deduction, exemption, credit or basis, for which there The applicant is entitled to a hearing if one is requested on
is no basis in fact or law. either Form CA-6 or on a separate written request. Form CA-6
is available at any Department of Revenue office or by calling
Inequitable Liability
(617) 887-MDOR. Mail the completed Form 84, Form CA-6 and
Whether it is inequitable to hold a person liable for a tax defi- all attachments to: Massachusetts Department of Revenue,
ciency will be determined by all the facts and circumstances of Customer Service Bureau, PO Box 7031, Boston, MA 02204.
a case. Although no single factor is controlling, consideration will
be given to whether the applicant significantly benefited from the Notice of Determination
substantial understatement of tax. A written notice of determination will be issued to the applicant.
A grant of relief will only apply to the extent specified in the writ-
Application for Relief
ten determination. The applicant remains jointly and severally li-
A taxpayer wishing to apply for relief must submit this form able for any amounts where relief is not granted. Also, the appli-
within the time prescribed for challenging an assessment or a cant’s spouse remains liable for the entire tax determined to be
proposed assessment under MGL Ch. 62C, sections 26 and 37. due. If the grant of relief was obtained by false or fraudulent
Applicants should attach copies of any federal claim for relief, means, the grant of relief is void.

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