Form 843, Claim for Refund and Request for Abatement Completed Form Examples and Samples
Explore practical examples of IRS Form 843, Claim for Refund and Request for Abatement. View detailed samples and learn how to accurately fill out your tax abatement request.
IRS Form 843: Requesting Penalty Abatement due to Reasonable Cause
How this form was filled:
This example illustrates how our AI extracts specific data from an informal email exchange between a taxpayer and their accountant to populate IRS Form 843. By identifying key narrative elements—such as the nature of the penalty, the justification for reasonable cause, and specific tax periods—the AI automates the otherwise tedious data entry process for tax professionals.
Source document used: Client Email to Accountant
Dear Sarah, I’m writing regarding the $1,250 penalty notice we received from the IRS last week. It relates to our late 941 employment tax filing for the period starting 01/01/2026 and ending 03/31/2026. As we discussed over the phone, our office manager, David Miller (SSN 000-12-3456), was hospitalized unexpectedly during the filing deadline, which prevented us from submitting the return on time. We paid the total employment tax due on 04/15/2026 and 05/01/2026. We are requesting an abatement of this civil penalty based on 'reasonable cause' given these extenuating circumstances. Our business address is 452 Maple Avenue, Suite 200, Springfield, IL 62704, and our Employer ID is 99-8877665. Please ensure we get this filed correctly. If you need to reach me, my cell is 217-555-0199. I have attached the original IRS notice, which references the 941 form. Our records show the payment of the penalty was cleared on 06/10/2026, though we are now disputing it. Let me know if you need anything else from David or myself to finalize the paperwork before the deadline.
Information used to fill out the document:
- Taxpayer Information: David Miller, SSN 000-12-3456, 452 Maple Avenue, Springfield, IL 62704
- Tax Period: 01/01/2026 to 03/31/2026
- Refund Amount: $1,250
- Penalty Reason: Reasonable cause (hospitalization of office manager)
- Tax/Return Type: Form 941 (Employment Tax)
- Payment Dates: 04/15/2026, 05/01/2026, 06/10/2026
What this filled form sample shows:
- Intelligent extraction of dates and SSNs from conversational text
- Mapping of unstructured justifications to the IRS 'Reasonable Cause' category
- Automatic identification of tax form types based on context (Form 941)
- Deduplication of address components into individual form fields
- Context-aware identification of specific penalty payment dates
Form specifications and details:
| Form: | IRS Form 843 |
| Category: | Abatement of penalty due to reasonable cause |
| Primary Use Case: | Requesting refund of employment tax penalty |
| Complexity: | Moderate |
| Target Audience: | Tax Professionals and Small Business Owners |
| Categories: | ABA forms, VA claim forms |
| Created: | May 25, 2026 07:09 PM |