Form Otr-10 Offer In Compromise
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1
2Item 5
I/we submit this offer to compromise the tax liabilities plus any interest,
District of Columbia
penalties, additions to taxes and additional amounts required by law (tax
Office of Tax and Revenue
liability) for the tax type and periods marked below:
Form OTR-10
Offer in Compromise
(If you need more space, use another sheet titled
Item 6
“Attachment to Form OTR-10", sign it and date it.)
I/we submit this offer for the reason(s) checked below:
Item 1
___________________________________________________________________
Taxpayer Name
o
_____________________________________________________________________________
Doubt as to Liability - I do not believe I owe this amount.
Street
Attached is my detailed explanation of the reasons I believe I do
not owe it.
_____________________________________________________________________________
City
State
Zip Code
o
Doubt as to Collectibility - I have insufficient assets and
______________________________________________________________________________
Mailing Address (if different from above)
income to pay the full amount. Attached are my complete
financial statements (Form PA-1 and/or PA-2), personal and
______________________________________________________________________________
business Federal Income Tax returns.
Street
Item 7
______________________________________________________________________________
City
State
Zip Code
I/we offer to pay
Item 2
$___________________________________
o
Names and Social Security Numbers of All Persons Submitting This Offer
In full with this offer. My check is attached.
o
Down payment of $___________________ is attached.
o
No down payment
Item 3
Check one of the following boxes
Business Tax Number(s)
o
o
o
o
o
Balance will be paid in
10
30
60 or
90
days from date of acceptance of the offer. If more than one
payment will be made during the time checked, provide the
amount of the payments and dates to be paid below.
o
Other proposed payment terms. Enter the specific dates
Item 4
Other Business Tax Numbers (of Related Businesses Not Included in Offer)
and amounts of the payments you propose on the lines below
6
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