Form Oic-1 - Offer In Compromise

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Georgia Department of Revenue
Offer in Compromise
(Revised July 2016)
• Complete and submit Form CD-14B (Collection Information Statement for Businesses) or CD-14C (Collection Information
Statement for Wage Earners and Self-Employed Individuals) with this application unless claiming Doubt as to Liability in
Section 3.
Section 1
Taxpayer Contact Information
Taxpayer’s First Name, Middle Initial, Last Name
Telephone Number
Taxpayer’s Social Security Number
If a Joint Offer, Spouse’s First Name, Middle Initial, Last Name
Telephone Number
Spouse’s Social Security Number
Business Name
Telephone Number
Employer Identification Number
(use if business making offer)
Taxpayer’s Address
(number, street, and room or suite no., city, state, ZIP code)
Mailing Address
(if different from above) (number, street, and room or suite no., city, state, ZIP code)
Section 2
Tax Periods
 To: State Revenue Commissioner:
In the following agreement, the pronoun "we" may be assumed in place of "I" when there are joint liabilities and both parties are
signing this agreement.
I submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts required by law for the tax type and
period(s) marked below:
Individual Income tax
Tax Year(s): ___________________________________________________________________________________
Employer Withholding tax
Tax Period(s): __________________________________________________________________________________
Sales and Use tax
Tax Period(s): __________________________________________________________________________________
Personal Liability as a responsible person of
(enter business name)
under O.C.G.A. § 48-2-52 for the following tax type(s) and tax period(s):
Sales Tax
Tax Period(s): ________________________________________________________________________________
Withholding Tax
Tax Period(s): ________________________________________________________________________________
Corporate income tax
Tax Year(s): ___________________________________________________________________________________
IFTA Fuel Tax
Tax Period(s): _________________________________________________________________________________
Other Tax Type: ________________________________ Tax Period(s): __________________________________________________________
Note: If you need more space, use a separate sheet of paper and title it “Attachment to Form OIC-1.”
Sign and date the attachment following the listing of
the tax periods.
Section 3
Reason for Offer
Doubt as to Collectibility — “I have insufficient assets and income to pay the full amount.” You must include a complete Statement of Financial
Condition (Form CD-14B or CD-14C).
Doubt as to Liability — “I do not believe I owe this amount.” You cannot submit an offer in compromise claiming both that you do not believe
the liability is correct (doubt as to liability) and that you are unable to pay it (doubt as to collectibility). You must include a detailed explanation of
the reason(s) on a separate sheet of paper detailing why you believe you do not owe the tax.
Economic Hardship — “I owe this amount and have sufficient assets to pay the full amount, but due to my exceptional circumstances, requiring
full payment would cause an economic hardship.” You must include a completed Statement of Financial Condition (Form CD-14B or
CD-14C) and submit a written narrative explaining your circumstances.
OIC-1 (rev. July 2016)
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