Form A-212 Petition For Compromise Of Taxes Based On Inability To Pay Page 4
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PETITIONER'S OFFER IN COMPROMISE
20.
In accordance with secs. 71.92(3), 73.13 and 77.62(5) of the Wisconsin Statutes, this petition is submitted by the undersigned who
declares under penalties of perjury that this petition, including accompanying schedules and statements, is true, correct and complete to the
best of his/her knowledge. The sum of $
is being offered to compromise the tax liability set forth in this petition.
It is understood that this offer in compromise only includes those taxes and taxable periods specifically identified on the petition.
It is understood that this offer does not provide relief from said liability until the offer is accepted in writing by the Department of
Revenue and paid within ten days from the date of such acceptance, or by installment schedule approved by the department.
It is mutually agreed that if within three years from the date this offer is accepted, the petitioner has income or property sufficient to
enable him/her to pay the remainder of the tax including penalty and interest, the department may reopen this matter and order payment in
full, or in part, of such tax, penalty and interest.
As a part of the consideration for this offer, the petitioner waives any claims to overpayments of taxes to which he/she may be entitled
for any of the years prior to and including those involved in this compromise settlement when the overpayments are not in excess of the
difference between the liability sought to be compromised and the amount offered. This waiver is withdrawn if the total amount of tax set forth
in this petition is paid in full within three years from the date the offer is accepted.
The petitioner also agrees that, as part of the consideration for this offer, they will withdraw or stipulate to dismiss any pending
administrative or other appeals against the department within 15 days of acceptance of this offer by the department. This includes, but is not
limited to, petitions for redetermination, appeals to the Tax Appeals Commission, and appeals to any state or federal court which relate to the
tax liability set forth in this petition. Petitioner further agrees to waive and release all claims against the department which relate to the tax
liability set forth in this petition.
Signature of petitioner (or corporate officer)
Title
Date
21.
COMPROMISE ORDER
On the basis of the sworn statement of the above-named petitioner, the Wisconsin Department of Revenue by its duly authorized
undersigned hereby determines:
That the petition for compromise is rejected.
That the petition for compromise offering the sum of $
in compromise of the petitioner's liablity which amounts to
$
is accepted. Therefore, the petitioner's liability as set forth in this petition is reduced to $
provided this sum is paid in the form of certified funds (cashiers check or money order) and received by the Department of Revenue
within 10 days from the date this offer was accepted.
That the department proposes a counter offer in the amount of $
in compromise of the petitioner's liability which
amounts to $
. Therefore, the petitioner's liability as set forth in this petition is reduced to $
provided this sum is paid in the form of certified funds (cashiers check or money order) and received by the Department of Revenue
within 20 days from the date this counter offer was made.
Correspondence dated
and enclosed with this petition contains additional conditions of your compromise. No
compromise adjustment to your account, including the satisfaction of tax warrants, will be made until all conditions have been met
unless the enclosed correspondence so states.
Signature
Date
22.
LOCATIONS OF DISTRICT OFFICES
Appleton
Eau Claire
Madison
Milwaukee
265 W. Northland Ave.
718 Clairemont Ave.
PO Box 8901
819 N. Sixth St.
54911
54701
2135 Rimrock Rd.
Rm. 408
(920) 832-2727
(715) 836-2811
53708
53203
(608) 266-7879
(414) 227-4000
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