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Form 12509 UT: What You Should Know

Title or Legal Description: “A Certificate of Authorization for the Permitted Use of Water of the State of Utah, for the Construction and Operation of a Water Reclamation Project in State of Utah”.  Title Type of Document: Certificate of Authorization.  Sole Prop. Of Name: “The Water Board of Utah”.  Branch and County of Permit: “Utah”. State of Utah Division of Water Rights.  City of Salt Lake City.  State of Utah. Date of Service: January 9, 2023 (D) How to use a form — fill-in, mail, fax, or email You can use this form at anytime and anyplace, in writing or to any recipient of any form— print or electronic. The completed form can be faxed to . You can use this form by mail, to send the completed form to : United States Department of the Treasury, Tax Administration, Box 3201, Room 3200, Treasury Building, Washington, DC 20230 Federal Form 12509 (IRS Statement of Disagreement) If you are claiming innocent spouse relief under the Unjust Enrichment Statute, you should include this form with the original or certified original of your claim and should submit original Form 12509 form to the IRS with the claim form and Form W-8BEN along with any supporting documents or supporting affidavits. Note that you cannot use this form in your appeal before the IRS, if you do not have a certified copy of your judgment or an order denying relief. To use this form in your claim, you should contact the IRS at the following number: US Treasury P.O. Box 4208 Washington, DC 20 This form is also available with an electronic version; see IRS.gov/FormDNR.pdf. You can also use this form in an IRS office, but it must be signed in ink. See Unintended Consequences of an Innocent Spouse Relief Claim. Unintended Consequences of Innocent Spouse Relief. If the IRS does not accept your form, write a check for 500 to the United States Treasury.

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