Form 9423 - Collection Appeal Request - 2014
ADVERTISEMENT
1
2Department of the Treasury - Internal Revenue Service
9423
Form
Collection Appeal Request
(August 2014)
(Instructions are on the reverse side of this form)
1. Taxpayer’s name
2. Representative (Attach a copy of Form 2848, Power of Attorney)
3. SSN/EIN
4. Taxpayer’s business phone
5. Taxpayer’s home phone
6. Representative’s phone
7. Taxpayer’s street address
8. City
9. State
10. ZIP code
11. Type of tax (Tax form)
12. Tax periods being appealed
13. Tax due
Collection Action(s) Appealed
14. Check the Collection action(s) you are appealing
Federal Tax Lien
Levy or Proposed Levy
Seizure
Rejection of Installment Agreement
Termination of Installment Agreement
Modification of Installment Agreement
Explanation
15. Explain why you disagree with the collection action(s) you checked above and explain how you would resolve your tax problem.
Attach additional pages if needed. Attach copies of any documents that you think will support your position. Generally, the Office of
Appeals will ask the Collection Function to review, verify and provide their opinion on any new information you submit. We will
share their comments with you and give you the opportunity to respond.
Under penalties of perjury, I declare that I have examined this request and any accompanying documents, and to the best of my knowledge and belief,
they are true, correct and complete. A submission by a representative, other than the taxpayer, is based on all information of which the representative
has any knowledge.
16.
17. Date signed
Taxpayer’s or
Authorized Representative’s signature (Only check one box)
IRS USE ONLY
18. Revenue Officer's name
19. Revenue Officer's signature
20. Date signed
21. Revenue Officer's phone
22. Revenue Officer's email address
23. Date received
24. Collection Manager’s name
25. Collection Manager’s signature
26. Date signed
27. Collection Manager’s phone
28. Collection Manager’s email address
29. Date received
9423
Department of the Treasury - Internal Revenue Service
Form
(Rev. 8-2014) Catalog Number 14169I
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial