Submit this form only with an application for certificate of Discharge of Property under IRC section 6325(b)(2)(A)
when relocation expenses are being requested in connection with the sale of a principal residence. Any amount
approved will be deducted from sale proceeds and will not reduce the amount of your tax liability. This allowance
is based upon inability to pay relocation expenses and is subject to limitations. To process your request, please
provide the information requested below. If additional information is needed, you will be contacted.