Fillable Form 656 - Offer In Compromise (Page 3 of 4) in pdf

Page 3 of 4

Section 6

Designation of Down Payment and Deposit

(Optional)

If you want your payment to be applied to a specific tax year and a specific tax debt, please tell us the tax form

and

Tax Year/Quarter

. If you do not designate a preference, we will apply any money you send in to the governments best interest.

If you are paying more than the required payment when you submit your offer and want any part of that payment treated as a deposit, check the box

below and insert the amount.

I am making a deposit of $

with this offer.

Section 7

Source of Funds

Tell us where you will obtain the funds to pay your offer. You may consider borrowing from friends and/or family, taking out a loan, or selling assets.

Include separate checks for the payment and application fee.

Make payable to the "United States Treasury" and attach to the front of your Form 656, Offer in Compromise. Do not send cash. Send a separate

application fee with each offer; do not combine it with any other tax payments, as this may delay processing of your offer. Your offer will be returned to

you if the application fee and the required payments are not properly remitted, or if your check is returned for insufficient funds.

Section 8

Offer Terms

By submitting this offer, I/we have read, understand and agree to the following terms and conditions:

Terms, Conditions, and Legal

a) I request that the IRS accept the offer amount listed in this offer application as payment of my outstanding tax

Agreement

debt (including interest, penalties, and any additional amounts required by law) as of the date listed on this form. I

authorize the IRS to amend Section 2 on page 1 in the event I failed to list any of my assessed tax debt.

IRS will keep my payments,

b) I voluntarily submit the payments made on this offer and understand that they are not refundable even if I

fees, and some refunds.

withdraw the offer or the IRS rejects or returns the offer. Unless I designated how to apply the required

payment (page 3 of this application), the IRS will apply my payment in the best interest of the government,

choosing which tax years and tax liabilities to pay off. The IRS will also keep my application fee unless the offer is

not accepted for processing.

c) The IRS will keep any refund, including interest, that I might be due for tax periods extending through the

calendar year in which the IRS accepts my offer. I cannot designate that the refund be applied to estimated tax

payments for the following year or the accepted offer amount. If I receive a refund after I submit this offer for any

tax period extending through the calendar year in which the IRS accepts my offer, I will return the refund as soon

as possible.

d) The IRS will keep any monies it has collected prior to this offer and any payments that I make relating to this

offer that I did not designate as a deposit. Only amounts that exceed the mandatory payments can be treated as a

deposit. Such a deposit will be refundable if the offer is rejected or returned by the IRS or is withdrawn. I

understand that the IRS will not pay interest on any deposit. The IRS may seize ("levy") my assets up to the time

that the IRS official signs and accepts my offer as pending.

Pending status of an offer

e) Once an authorized IRS official signs this form, my offer is considered pending as of that signature date and it

and right to appeal

remains pending until the IRS accepts, rejects, returns, or terminates my offer or I withdraw my offer. An offer will

be considered withdrawn when the IRS receives my written notification of withdrawal by personal delivery or

certified mail or when I inform the IRS of my withdrawal by other means and the IRS acknowledges in writing my

intent to withdraw the offer.

f) I waive the right to an Appeals hearing if I do not request a hearing within 30 days of the date the IRS notifies

me of the decision to reject the offer.

I must comply with my future

g) I will file tax returns and pay required taxes for the five year period beginning with the date of acceptance of this

tax obligations and

offer, or until my offer is paid in full, whichever is longer. If this is an offer being submitted for joint tax debt, and

understand I remain liable for

one of us does not comply with future obligations, only the non-compliant taxpayer will be in default of this

the full amount of my tax

agreement.

debt until all terms and

conditions of this offer have

h) The IRS will not remove the original amount of my tax debt from its records until I have met all the terms and

been met.

conditions of this offer. Penalty and interest will continue to accrue until all payment terms of the offer have been

met. If I file for bankruptcy before the terms are fully met, any claim the IRS files in the bankruptcy proceedings

will be a tax claim.

i) Once the IRS accepts my offer in writing, I have no right to contest, in court or otherwise, the amount of the tax

debt.

I understand what will

j) If I fail to meet any of the terms of this offer, the IRS may levy or sue me to collect any amount ranging from the

happen if I fail to meet the

unpaid balance of the offer to the original amount of the tax debt without further notice of any kind. The IRS will

terms of my offer (e.g.,

continue to add interest, as Section 6601 of the Internal Revenue Code requires, on the amount the IRS

default).

determines is due after default. The IRS will add interest from the date I default until I completely satisfy the

amount owed.

I agree to waive time limits

k) To have my offer considered, I agree to the extension of the time limit provided by law to assess my tax debt

provided by law.

(statutory period of assessment). I agree that the date by which the IRS must assess my tax debt will now be

the date by which my debt must currently be assessed plus the period of time my offer is pending plus one

additional year if the IRS rejects, returns, or terminates my offer or I withdraw it. (Paragraph (e) of this section

defines pending and withdrawal). I understand that I have the right not to waive the statutory period of

assessment or to limit the waiver to a certain length or certain periods or issues. I understand, however, that the

656

Catalog Number 16728N

Form

(Rev. 3-2011)

Form 656 - Offer In Compromise Page 3

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