• Form 843(Rev. December 2024)Department of the TreasuryInternal Revenue Service

  • Claim for Refund and Request for Abatement

  • Go to www.irs.gov/Form843 for instructions and the latest information.
  • OMB No. 1545-0024

  • Check the box below that indicates your reason for filing Form 843.

  • Tax
  • Penalty
  • Interest
  • Other
  • CAUTION: Do not use Form 843 when you must use a different tax form. For example, do not use Form 843 to claim a refund or abatement of an overpayment of income taxes or an employer's claim for FICA tax, RRTA tax, or income tax withholding; a refund of excise taxes based on the nontaxable use or sale of fuels; or an overpayment of excise taxes reported on Form(s) 11-C, 720, 730, or 2290. Also, do not use Form 843 to claim a refund of tax return preparer or promoter penalties. See instructions for the forms to use.
  • Format: (000) 000-0000.

  • 1 Enter the tax period or fee year. Prepare a separate Form 843 for each tax period or fee year.

  • Beginning date (MM/DD/YYYY)
     - -
    2 digit month, 2 digit day, 4 digit year
  • Ending date (MM/DD/YYYY)
     - -
    2 digit month, 2 digit day, 4 digit year

  • 3 Date(s) of payments) for which you are requesting a refund MM/DD/MY. If you need more space, attach additional sheets.

  • 4 Check the box(es) with the type of tax or fee for which you are asking a refund or abatement. Or check the box(es) with the type of tax or fee to which the interest, penalty, or addition to tax is related. Check only one box unless an exception applies (see Special Instructions in the instructions for the exceptions).

  • Form 843 (Rev. 12-2024)

  • 5 Indicate the type of fee or return, if any, filed to which the tax, interest, penalty, or addition to tax relates. Check only one box unless an exception applies (see Special Situations in the instructions for the exceptions)
  • 7 Check the box that indicates your reason for the request for refund or abatement.
  • Signature. If you are filing Form 843 to request a refund or abatement relating to a joint return, both you and your spouse must sign the Form 843. Forms 843 filed by corporations must be signed by a corporate officer authorized to sign, and the officer's title must be included with the signature. Forms 843 filed by an estate or trust must be signed by the fiduciary.

    Under penalties of perjury, I declare that I have examined this claim, including accompanying schedules and statements, and, to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
  • Clear
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Clear
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Paid Preparer Use Only

  • Clear
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
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