Form Oic-1 - Offer In Compromise

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Georgia Department of Revenue
OIC-1
Form
Offer in Compromise
(March 2011)
PLEASE READ:
• Use this form to compromise all state tax liabilities except for individual income tax liabilities less than $25,000 (use
Form OIC-1S instead).
• Complete and submit Form CD-14B (Statement of Financial Condition for Businesses) and/or CD-14C (Statement of
Financial Condition for Wage Earners and Self-Employed Individuals) with this application as applicable.
SECTION 1
Taxpayer Contact Information
Taxpayer’s First Name
Middle Initial
Last Name
Social Security Number
If a joint offer, spouse’s First Name
Middle Initial
Last Name
Social Security Number
Business Name
(use if business making offer)
Employer Identification Number
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
Submission of Offer
I/We (includes all types of taxpayers) submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and
additional amounts required by law (tax liability) for the 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), adding additional periods if needed).
Individual income tax
Year(s):
Employer withholding tax
Period(s):
Sales and use tax
Period(s):
Personal liability for sales tax or withholding tax delinquency under O.C.G.A. § 48-2-52 as a responsible person for the listed business
and periods:
Business Name
Employer Identification Number
Period(s)
Corporate income tax
Year(s):
IFTA Fuel Tax
Period(s):
Other Tax Type:
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 in Compromise
I/We submit this offer for the reason(s) checked below:
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 and/or CD-14C).
Economic Hardship — “Due to my exceptional circumstances, requiring full payment would cause an economic hardship.” You
must include a complete Statement of Financial Condition (Form CD-14B and/or CD-14C) and complete Section 7 of this
application.
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). Do not
complete Form CD-14A. You must include a detailed explanation of the reason(s) why you believe you do not owe the tax by
completing Section 7 of this application.
OIC-1
Page 1

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