Federal IRS Statement of Disagreement

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IRS Statement of Disagreement
Form 12509 (Rev. 01-2005)
Form 12509
(January 2005)

Statement of Disagreement

Purpose of form: You can use this form to explain why you disagree with the Internal Revenue Service (IRS)
Determination concerning relief from joint and several liability for a joint return under Internal Revenue Code sections
6013(e), 6015(b), 6015(c), or 6015(f) in the letter you received with this form.
Note: You can use the back of this page or attached additional pages if you need more space.

CHECK HERE IF YOU ALSO WISH TO GO TO APPEALS
Taxpayer Name:

Social Security Number

Statement of Disagreement
I,

, disagree with the Internal Revenue Service determination because

Under penalties of perjury, I declare that I have examined this statement, and to the best of my knowledge and belief, it is
true, correct and complete.
My Signature

Date

Daytime phone number

Best time to Call

Form 12509 (Rev. 1-2005)
www.irs.gov

Catalog Number 28731A

Department of the Treasury-Internal Revenue Service



More about the Federal Form 12509 Other TY 2022

You can use this form to explain why you disagree with the Internal Revenue Service (IRS) Determination concerning relief from joint and several liability for a joint return under Internal Revenue Code sections 6013(e), 6015(b), 6015(c), or 6015(f) in the letter you received with this form.

We last updated the IRS Statement of Disagreement in January 2023, so this is the latest version of Form 12509, fully updated for tax year 2022. You can download or print current or past-year PDFs of Form 12509 directly from TaxFormFinder. You can print other Federal tax forms here.

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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 12509 from the Internal Revenue Service in January 2023.

Show Sources >

• Original Form PDF is https://www.irs.gov/pub/irs-access/f12509_accessible.pdf
• Federal Internal Revenue Service at http://www.irs.gov/

Historical Past-Year Versions of Federal Form 12509

We have a total of ten past-year versions of Form 12509 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:

2022 Form 12509

Form 12509 (Rev. 01-2005)

2021 Form 12509

Form 12509 (Rev. 01-2005)

2020 Form 12509

Form 12509 (Rev. 01-2005)

2019 Form 12509

Form 12509 (Rev. 01-2005)

2018 Form 12509

Form 12509 (Rev. 01-2005)

2017 Form 12509

Form 12509 (Rev. 01-2005)

2016 Form 12509

Form 12509 (Rev. 01-2005)

2015 Form 12509

Form 12509 (Rev. 1-2005)

2012 Form 12509

Form 12509 (Rev. 1-2005)

2011 Form 12509

Form 12509 (Rev. 1-2005)

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