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

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Explanation of Circumstances
(Individual Taxpayer/ Business Taxpayer)
Please explain why the Department of Finance and Administration should consider this Offer in Compromise. Please
include a statement as to why tax was not collected or remitted for the period for which the offer is being made. If any
liabilities listed on the financial statements (433 A/B forms) are the result of debts to family members, please
specifically detail the nature of the debt and the family relationship. Use the space below and attach additional
sheets if necessary.
_______________________________________
________________________________________________
Taxpayer’s or Business Name (printed)
Prepared by (if other than taxpayer)
_______________________________________
_____________
___________________________
Signature of Taxpayer or Business Owner
Date
Corporate Title (if applicable)
_______________________________________
Spouse’s Name (if applicable) (printed)
___________________________________
___________
Signature of Spouse (if applicable)
Date
4
Rev 08/2008

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