Form 656 - Offer In Compromise

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IRS
Form 656
IRS RECEIVED DATE
Offer in Compromise
Department of the Treasury
Internal Revenue Service
Item 1 — Taxpayer’s Name and Home or Business Street Address
_________________________________________________
Form 656 (Rev. 7-2004)
Name
Catalog Number 16728N
_________________________________________________
Name
_________________________________________________
Attach
Street Address
_________________________________________________
Application
City
State
ZIP Code
Fee
(check or
Mailing Address (if different from above)
money order)
here.
_________________________________________________
Street Address
DATE RETURNED
_________________________________________________
City
State
ZIP Code
Item 6 — I/We submit this offer for the reason(s) checked below:
Item 2 — Social Security Numbers
❑ Doubt as to Liability — “I do not believe I owe this tax.”
____________________________________
(a) Primary
You must include a detailed explanation of the reason(s) why
____________________________________
you believe you do not owe the tax in Item 9.
(b) Secondary
❑ Doubt as to Collectibility — “I have insufficient assets and
Item 3 — Employer Identification Number (included in offer)
income to pay the full amount.” You must include a complete
Collection Information Statement, Form 433-A and/or Form 433-B.
____________________________________________________
❑ Effective Tax Administration — “I owe this amount and have
Item 4 — Other Employer Identification Numbers (not included
sufficient assets to pay the full amount, but due to my exceptional
in offer) ______________________________________________
circumstances, requiring full payment would cause an economic
____________________________________________________
hardship or would be unfair and inequitable.” You must include a
____________________________________________________
complete Collection Information Statement, Form 433-A and/or
Form 433B and complete Item 9.
Item 5 — To: Commissioner of Internal Revenue Service
Item 7
I/We (includes all types of taxpayers) submit this offer to
/
I
We offer to pay $ ________________ (must be more than zero).
compromise the tax liabilities plus any interest, penalties, additions
to tax, and additional amounts required by law (tax liability) for the
Complete item 10 to explain where you will obtain the funds to make
this offer.
tax type and period marked below: (Please mark an “X” in the box
for the correct description and fill-in the correct tax period(s),
Check only one of the following:
adding additional periods if needed).
❑ Cash Offer (Offered amount will be paid in 90 days or less.)
❑ 1040/1120 Income Tax — Year(s) _______________________
__________________________________________________
Balance to be paid in: ❑ 10, ❑ 30, ❑ 60, or ❑ 90 days from written
notice of acceptance of the offer.
❑ 941 Employer’s Quarterly Federal Tax Return — Quarterly
period(s) ___________________________________________
❑ Short-Term Deferred Payment Offer (Offered amount paid in
__________________________________________________
MORE than 90 days but within 24 months from written notice
❑ 940 Employer’s Annual Federal Unemployment (FUTA) Tax
of acceptance of the offer.)
Return — Year(s) ____________________________________
$________________within_____________days (not more than 90
__________________________________________________
— See Instructions Section, Determine Your Payment Terms)
from written notice of acceptance of the offer; and/or
❑ Trust Fund Recovery Penalty as a responsible person of
(enter corporation name) ______________________________
beginning in the _________ month after written notice of acceptance
_________________________________________________ ,
of the offer $________________on the ___________day of each
for failure to pay withholding and Federal Insurance
month for a total of ____________months. (Cannot extend more than
Contributions Act Taxes (Social Security taxes), for period(s)
24 months from written notice of acceptance of the offer.)
ending ____________________________________________ .
❑ Deferred Payment Offer (Offered amount will be paid over
❑ Other Federal Tax(es) [specify type(s) and period(s)] ________
the remaining life of the collection statute.)
___________________________________________________
$________________within_____________days (not more than
Note: If you need more space, use another sheet entitled
90 — See Instructions Section, Determine Your Payment Terms)
“Attachment to Form 656 Dated _________________ .”
from written notice of acceptance of the offer; and
Sign and date the attachment following the listing of
the tax periods.
beginning in the first month after written notice of acceptance of
the offer $________________on the ___________day of each month
for a total of ____________months.
21

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