Form 2000-4 - Settlement Or Compromise Of Tax Liability Form - Arkansas Department Of Finance And Administration Page 2
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6Item 6 – To: Commissioner of Revenue
I/We 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 marked below. Mark an “X” in the box by the correct type of tax
and list the period(s) included in your offer.
Individual Income Tax – List Year(s)
Withholding Tax – List Months and Years
Sales/Use Tax – List Months and Years
Other Tax(es)
Type(s)
Months/Years
Note: If you need more space, attach a separate page.
Item 7 – Bankruptcy
List all prior bankruptcies. Attach separate sheet if needed. Please list NA, if not applicable.
Date Filed
Docket Number
Date of Discharge or Dismissal
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Rev 08/2008
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