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Form 2000-4 - Settlement Or Compromise Of Tax Liability Form - Arkansas Department Of Finance And Administration Page 3

Item 8 – Why is a payment plan (equal monthly payments over specified period of time) not an

option to settle this liability?

Item 9 - I/We submit this offer for the reason(s) checked below:

Controversy Over Amount of Tax Due – “

I do not believe I owe this amount.” You must include a

detailed explanation of the reasons why you believe you do not owe the tax.

Insolvency – “

I have insufficient assets and income to pay the full amount.” REFER TO CHECKLIST FOR

ADDITIONAL ITEMS THAT MUST BE SUBMITTED WITH THIS FORM.

Item 10 – Amount of offer.

This amount cannot be zero.

I/we offer to pay $______________.

Paid in full with this offer.

Paid in full within 30 days of acceptance of this offer by the Arkansas Department of Finance and

Administration.

Note: Make all checks payable to: Arkansas Department of Finance and Administration.

Payments other than cash must be made with certified funds, such as a cashier’s check or money order.

Payment by credit card is available for individual income tax only.

List the source of the funds in Item #10 on the line below:

By submitting this offer, I/we understand and agree to the following condition:

/We understand that I/we remain responsible for the full amount of the tax liability, unless and until the

Department of Finance and Administration accepts the offer in writing and I/we have met all the terms

and conditions of the offer. The Department will not remove the original amount of the tax liability from

its records until I/we have met all the terms of the offer.

Rev 08/2008

Form 2000-4 - Settlement Or Compromise Of Tax Liability Form - Arkansas Department Of Finance And Administration Page 3