Fillable Form 14039

What is Form 14039?

Form 14039, Identity Theft Affidavit, is a form that allows the taxpayer to inform the IRS that you were a victim of identity theft. This form allows the IRS to prompt an investigation to resolve the fraudulent tax issue.

You must call the IRS immediately when you realized that there was a fraudulent tax return and your Social Security Number (SSN) was used. Once you have confirmed that your identity has been stolen, you may now start filling your Form 14039.

You may download a PDF copy of the 14039 form on the IRS website. You may also electronically fill it out on PDFRun for your convenience.

How to fill out Form 14039?

Provide the necessary information in the fields below. Make sure to read the instructions carefully.

Section A - Check the following boxes in this section that apply to the specific situation you are reporting

Check the appropriate box to determine the specific situation you are reporting to the IRS. You may select:

• 1. I am submitting this Form 14039 for myself
• 2. This Form 14039 is submitted in response to a ‘Notice’ or ‘Letter’ received from the IRS
• 3. I am submitting this Form 14039 on behalf of my ‘dependent child or dependent relative’
• 4. I am submitting this Form 14039 on behalf of another person (other than my dependent child or dependent relative

If you checked option two, provide the ‘Notice’ or ‘Letter’ numbers on the line to the right. Check option one in Section B and see special mailing and faxing instructions on the reverse side of this form.

If you checked option three and option four, complete Section E of this form.

Section B - Reason For Filing This Form (required)

Check only one of the following boxes to determine what applies to the person listed in Section C below. You may select:

• 1. Someone used my information to file taxes, including being incorrectly claimed as a dependent
• 2. I don’t know if someone used my information to file taxes, but I’m a victim of identity theft

If the taxpayer in Section C has previously submitted a Form 14039 to the IRS on the same affected tax years, you don’t need to submit another 14039 IRS form.

Provide an explanation of the identity theft issue, how it is related to your tax account, how you became aware of it, and provide relevant dates.

Enter your explanation regarding the identity theft issue, how it is related to your tax account, how you became aware of it, and provide any relevant dates. You may attach additional information and pages to this form if needed.

Section C - Name and Contact Information of Identity Theft Victim

This section requires your personal information as an identity theft victim.

Victim’s last name, First name, Middle Initial

Enter the victim’s full legal name starting with the last name, followed by the first name and middle initial.

Taxpayer Identification Number

Enter your taxpayer identification number. You may also enter your nine-digit Social Security Number.

Current mailing address

Enter your current mailing address. Include your apartment or suite number or P.O. Box. Enter the victim’s last known address if they are already deceased.

Current City

Enter the current city of your mailing address.

State

Select from the drop-down list the state of your mailing address.

ZIP Code

Enter the ZIP code of your mailing address.

Tax Year(s) you experienced identity theft

Enter the tax year(s) you experienced identity theft. Enter “Unknown” if you do not know the year.

What is the last year you filed a return

Enter the last year you filed a return.

Address used on last filed tax return

Enter the address you used on your last filed tax return if it is different from your current address.

City

Enter the city you used on the last tax return filed if it is different from your current address.

State

Select from the drop-down list the state you used on the last tax return filed if it is different from your current address.

ZIP Code

Enter the ZIP code you used on the last tax return filed if it is different from your current address.

Name used on last filed tax return

Enter the name used on the last filed tax return if it is different from the current name.

Telephone number with area code

Enter your telephone numbers. This field is optional. Indicate “Deceased” if the victim is already deceased.

Home phone number

Enter your home phone number.

Cellphone number

Enter your cellphone number.

Best time(s) to call

Enter the best time IRS can call you.

Language in which you would like to be contacted

Mark the appropriate box to determine the language you like to be contacted. You may select:

• English
• Spanish

Section D - Penalty of Perjury Statement and Signature (required)

This section confirms that everything you entered in the IRS form 14039 is true, correct, complete, and made in good faith. Otherwise, you will be penalized for perjury.

Signature of taxpayer, or representative, conservator, parent, or guardian

Affix your signature.

Date Signed

Enter the date you signed this form.

Section E - Representative, Conservator, Parent, or Guardian Information

Fill out this section only if you are completing Form 14039 IRS on someone else’s behalf.

Check only one of the appropriate boxes to determine the reason you are submitting this form. You may select:

• 1. The taxpayer is deceased and I am the surviving spouse
• 2. The taxpayer is deceased and I am the court-appointed or certified personal representative
• 3. The taxpayer is deceased and a court-appointed or certified personal representative has not been appointed
• 4. The taxpayer is unable to complete this form and I am the appointed conservator or have the Power of Attorney/Declaration of Representative authorization per IRS Form 2848
• 5. The person is my dependent child or my dependent relative

If you checked option one, you don’t need to submit any attachments, including a death certificate. If you checked option two, attach a copy of the court certificate showing your appointment.

If you checked option three, attach a copy of the death certificate or formal notification from a government office informing the next of kin of the decedent’s death. Mark the appropriate box to indicate your relationship to the decedent. You may select:

• Child
• Parent/Legal Guardian
• Other

If you marked “Other,” enter the type of relationship you have with the decedent.

If you checked option four, attach a copy of documentation showing your appointment as conservator or POA authorization. Enter your IRS-issued nine-digit Centralized Authorization File (CAF) number, if any.

If you checked option five, you are indicating that you are an authorized representative as parent, guardian, or legal guardian to file a legal document on the dependent’s behalf. Mark the appropriate box to indicate your relationship to the dependent. You may select:

• Parent/Legal Guardian
• Power of Attorney
• Fiduciary Relationship per IRS Form 56
• Other

Representative’s Name

Enter your full legal name.

Representative’s current mailing address

Enter your current mailing address, including the city, town or post office, state, and ZIP code.

Representative’s telephone number

Enter your telephone number.

How to file Form 14039?

Submit the completed 14039 form to IRS via Mail or FAX to a specialized IRS processing area dedicated to assisting you. Make sure to choose only one method of submitting this form, and provide clear and readable photocopies of any additional information or documents you will provide. Note that tax returns may not be submitted through mail or FAX number.

If you checked Option One in Section B in response to a notice or letter received from the IRS and you are submitting it via mail, return this form and a copy of the notice or letter to the address contained in the said notice or letter. If it has a FAX number, send them there. Otherwise, follow the instructions on the notice or letter. Make sure to include a cover sheet marked “Confidential.”

If you checked Option Two in Section B, and you are unable to file your tax return electronically because the primary or secondary SSN was misused, attach this form to the back of your paper tax return and submit it to the IRS location where you file your tax return.

If there are no current tax-related issues, you may mail it to the Department of Treasury, Internal Revenue Service, at Fresno, CA. Otherwise, you may FAX this form to 855-807-5720 toll-free.

If you have filed your paper return, you may submit Form 14039 to the IRS where you normally file your tax return.