TAXPAYER: [taxpayer's name]
TIN: [taxpayer's TIN]
OTHER TAXPAYER: [spouse's name]
TIN: [other spouse's TIN]
TYPE OF TAX: Income
YEARS OR PERIODS: [years or periods involved]

1. I am requesting information on behalf of [NAME OF CLIENT] for an assessed deficiency of tax with respect to a joint return filed by the captioned taxpayers for taxable year [TAXABLE YEAR].
   
   
2. [NAME OF CLIENT] is no longer married to [or no longer residing in the same household with] [NAME OF OTHER SPOUSE].
   
   
3. Please send me the a written statement with respect to the following: (A) whether the IRS has attempted to collect such deficiency from [NAME OF OTHER SPOUSE]; (B) the general nature of such collection activities; and (C) the amount collected.
   
   
4. The above referenced taxpayer is entitled to the requested information under the authority of Internal Revenue Code sections 6103(e)(1)(A) and 6103(e)(8).
   
   
5. In accordance with Treasury Regulation section 601.702(c)(4)(ii), enclosed is a form 2848 (power of attorney).
   
   
6. In accordance with Treasury Regulation section 601.702(c)(4)(ii)(B), enclosed is a photocopy of my current New York State driver's license. My address appears at the top of this letter and my signature appears at the end.
   
   
7. Please send notification of the determination on this request to:

   [NAME AND ADDRESS OF REPRESENTATIVE]

8. I am requesting that copies be made and furnished without my prior inspection.
   
   
9. I attest, under penalty of perjury, that this request is for an "other requester" as defined by Treasury Regulation section 601.702(f)(3)(E).
   
   
10. I agree to pay the fees for search and duplication cost ultimately determined in accordance with Treasury Regulation section 601.702(f).