Catalog Number 52525A www.irs.gov
Form
14039 (Rev. 5-2024)
Section F – Representative, Conservator, Parent or Guardian Information (required if completing Form 14039 on someone else’s behalf)
Check only ONE of the following five boxes next to the reason you are submitting this form
1. The taxpayer is deceased, and I am the surviving spouse
• No attachments are required, including death certificate.
2. The taxpayer is deceased, and I am the court-appointed or certified personal representative
• Attach a copy of the court certificate showing your appointment.
3. The taxpayer is deceased, and a court-appointed or certified personal representative has not been appointed
• Attach copy of death certificate or formal notification from a government office informing next of kin of the decedent’s death.
• Indicate your relationship to decedent: Child Parent/Legal Guardian Other
4. The taxpayer is unable to complete this form and I am the appointed conservator, or I have been authorized to act on behalf of the
taxpayer per Form 2848, Power of Attorney and Declaration of Representative
• Attach a copy of documentation showing your appointment as conservator or Power of Attorney authorization.
• If you have an IRS issued Centralized Authorization File (CAF) number, enter the nine-digit number:
5. The person listed above is my dependent child or my dependent relative
By checking this box and signing below 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.
• Indicate your relationship to person Parent/Legal Guardian
Fiduciary per IRS Form 56, Notice of Fiduciary Relationship
Power of Attorney
Other
Parent’s/Representative's name
Last name First name Middle initial
Parent’s/Representative’s current mailing address (city, town or post office, state, and ZIP code)
Parent’s/Representative’s telephone number
Instructions for Submitting this Form
Submit this completed and signed form to the IRS via Online, Mail or FAX to specialized IRS processing areas dedicated to assist you.
In Section C of this form, be sure to include the Social Security Number in the ‘Taxpayer Identification Number’ field.
Help us avoid delays:
• Do not use this form if you have already filed a Form 14039 for this incident.
• Choose one method of submitting this form either Online (preferred method), by Mail, or by FAX, not all methods.
• Provide clear and readable photocopies/images of any additional information you may choose to provide.
• Submit the original tax return to the IRS location where you normally file your tax return. Do not use the following address or fax number to file an
original tax return.
Privacy Act and Paperwork Reduction Notice
Our legal authority to request the information is 26 U.S.C. 6001. The primary purpose of the form is to provide a method of reporting identity theft issues to the IRS so that the IRS may document
situations where individuals are or may be victims of identity theft. Additional purposes include the use in the determination of proper tax liability and to relieve taxpayer burden. The information may
be disclosed only as provided by 26 U.S.C. 6103. Providing the information on this form is voluntary. However, if you do not provide the information it may be more difficult to assist you in resolving
your identity theft issue. If you are a potential victim of identity theft and do not provide the required substantiation information, we may not be able to place a marker on your account to assist with
future protection. If you are a victim of identity theft and do not provide the required information, it may be difficult for IRS to determine your correct tax liability. If you intentionally provide false
information, you may be subject to criminal penalties. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a
valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law.
Generally, tax returns and return information are confidential, as required by section 6103. Public reporting burden for this collection of information is estimated to average 15 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have
comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax
Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send this form to this address. Instead, see the form for filing
instructions. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information
subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.
Section E – Penalty of Perjury Statement and Signature (required)
Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered on this Form 14039 is true, correct, complete, and
made in good faith.
Signature of taxpayer, or representative, conservator, parent or guardian
Date signed
Online (Preferred Method)
• https://apps.irs.gov/app/digital-mailroom/dmaf/f14039/
Submitting by FAX
• Always include a cover sheet marked "Confidential”.
• If you checked Box 2 in Section A of Form 14039 and are submitting
this form in response to a notice or letter received from the IRS. If it
provides a FAX number, you should send there.
• If no FAX number is shown on the notice or letter, follow the mailing
instructions on the notice or letter.
• For all others, FAX this form toll-free to:
855-807-5720
Submitting by Mail
• If you checked Box 2 in Section A in response to a notice or letter
received from the IRS, return this form and if possible, a copy of the
notice or letter to the address contained in the notice or letter.
• If you checked Box 1 or 2 in Section B of Form 14039 and are unable
to file your tax return electronically because the SSN/ITIN of you,
your spouse, or dependent was misused, attach this Form 14039 to
the back of your paper tax return and submit to the IRS location where
you normally file your tax return.
• All others should mail this form to:
Department of the Treasury
Internal Revenue Service
Fresno, CA 93888-0025