UNITED STATES TAX COURT

_____________________________________             	)
Petitioner(s)						)
                       v.				)    Docket No.______________________
COMMISSIONER OF INTERNAL REVENUE,       		)
Respondent        					)

STATEMENT OF TAXPAYER IDENTIFICATION NUMBER (E.g., Social Security number(s), employer identification number(s))

Name of Petitioner_____________________________________________________
Petitioner’s Taxpayer Identification Number_________________________________
Name of Additional Petitioner____________________________________________
Additional Petitioner’s Taxpayer Identification Number________________________

If either petitioner is seeking relief from joint and several liability on a joint return pursuant to Section 6015, I.R.C. 1986, and Rules 320 through 325, name of the other individual with whom petitioner filed a joint return:
__________________________________________

Taxpayer Identification Number of the other individual, if available:
__________________________________________

__________________________________________          _________________
       SIGNATURE OF PETITIONER OR COUNSEL         DATE

__________________________________________          _________________
      SIGNATURE OF ADDITIONAL PETITIONER          DATE