Transcription of Fill-In Form Instructions
1 Fill-In form Instructions :Tax Court forms can be filled in and printed directly from Actobat Reader (or later). However, the information entered on a form cannot be saved to a disk unless you areusing the full Adobe Acrobat software on a form link will launch the Acrobat Reader plug-in and display the formwithin your browser window (please note the Acrobat toolbar that appears across thetop of the form within the browser). You may also wish to download the form directly toyour hard drive to fill in later. To do so, right-click on the form link and select SaveTarget (Internet Explorer) or Save Link (Netscape Navigator) to save theform file to a In the form : Move the mouse pointer over a blank field ( Petitioner(s) name(s)) on theform. The mouse pointer will turn into a vertical I-beam, indicating that the fieldis editable.
2 Click the left mouse button once within the field and begin typing. Press the tab key to move forward through the form . Press shift+tab to movebackwards. When you have completed the form , click once on a blank area of the form todeselect the last active field. If a field is left active, the information it contains willnot print. Click the print icon on the Acrobat Reader toolbar to print the STATES TAX COURTWASHINGTON, DC 20217 ,Petitioner (your name) OF INTERNAL REVENUE,Respondent Docket No. APPLICATION FOR WAIVER OF FILING FEE1. Do you receive any money from any of the following sources? If Yes , amount received per month:a. Salary or wagesG YES G NOb.
3 Business, profession, or other self-employmentG YES G NOc. Rent payments, interest, or dividendsG YES G NOd. Pensions, annuities, or life insurance paymentsG YES G NOe. Disability or workers compensation paymentsG YES G NOf. Any other sourcesG YES G NO2. Do you have any cash or checking or savings accounts?G YES G NOIf Yes , state the total amount. _____3. Do you own any real estate, stocks, bonds, securities, other financial instruments, automobiles, orany other thing of value?G YESG NOIf Yes , describe the property and state its value.(08/13)1 of 24. List the persons who depend on you for support (if under 18, list initials only), state yourrelationship to each person, and indicate how much you contribute to their support per Do you have any debts, financial obligations or other additional circumstances you want the Court toconsider (such as incarceration) in deciding whether to waive the filing fee?
4 If yes, describe theamounts owed and to whom they are payable and the other circumstances you want declare under penalty of perjury that the above information is true and _____ DateSignature of ApplicantReturn the completed application to:Office of Clerk of the CourtUnited States Tax Court400 Second Street, NWWashington, DC 202172 of 2
