Fillable Printable Form M-8379
Fillable Printable Form M-8379
Form M-8379
Massachusetts Department of Revenue
Form M-8379
Nondebtor Spouse Claim and Allocation for Refund Due
Rev. 5/16
Important: Read the instructions below before completing this form to be sure you are eligible to file.
Tax year of expected refund:
Please print or type. Names and address must appear as they did on the joint return for the tax year in question.
Name Social Security number Fill in if nondebtor spouse
Street address
City/Town State Zip
Name of spouse (if filing joint return) Social Security number Fill in if nondebtor spouse
Name of executor(s) (see instructions) Designation
Street address
City/Town State Zip
c. Joint (as filed)
Allocation items a. Nondebtor spouse b. Other spouse (add col. a and col. b)
11 Total income (list all sources) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
12 Adjustments to income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
13 Deductions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
15 Credits against tax (do not include Limited Income Credit) . . . . 5
16 Taxes withheld (include copies of all Forms W-2) . . . . . . . . . . . 6
17 Tax payments (amounts paid with return, estimated, etc.) . . . . . 7
Fill in if the refund due is being requested in the nondebtor spouse’s name only.
2016
Declaration
Under penalties of perjury, I declare that I have examined this form, and to the best of my knowledge it is true, correct and complete. Dec lar a -
tion of preparer (other than taxpayer) is based on all information of which the preparer has knowledge.
Signature of nondebtor spouse Date
Signature of paid preparer Date Social Security number
Are You Eligible to File this Form?
You may file this form if:
• you filed a joint Massachusetts tax return with an overpayment ap-
plied against the past due income tax debt of your spouse;
• you received income; and
• you made tax payments through withholding or estimated tax
payments.
You may not file this form if:
• your joint refund has been or will be applied to past due tax owed
jointly to the Commonwealth of Massachusetts;
• you, as an individual, filed jointly but made no tax payments for the
tax year at issue; or
• you are liable for any past due tax payments to the Common wealth
of Massachusetts.
Enter the appropriate information from the tax return in question where
requested. The Department of Revenue will calculate your nondebtor
refund based on married filing separate status.
Tax refunds applied to satisfy unpaid debts to other state agencies
must be appealed directly to that state agency. Over pay ments applied
to child support must be appealed to Child Support Enforcement.
Mail form to: Massachusetts Department of Revenue, PO Box 7010,
Boston, MA 02204.
