Form 433-A - How To Prepare Form 433-A And Templates Page 2
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6TOTAL INCOME - If only one spouse has a tax
liability, but both have income, list the total
household income and expenses.
Items 31 & 32-Wages
Enter your gross monthly wages and/or salaries. Do
not deduct withholding or allotments you elect to
take out of your pay such as insurance, credit union
deductions, car payments, etc. List these
deductions in Necessary Living Expenses.
Item 34 - Net Business Income
Enter your monthly net business income and include
Form 433-B.
NECESSARY LIVING EXPENSES - To be necessary,
expenses must provide for the health and welfare of
you and your family and/or provide for the
production of income, and must be reasonable in
amount. We may ask you to provide substantiation
of certain expenses.
Item 42 - House and Utilities
Enter the monthly rent or mortgage payment for
your principal residence. Add the average monthly
payment for the following expenses, if they are not
included in your rent or mortgage payments,
property taxes, homeowner's or renter's insurance,
necessary maintenance and repair, homeowner
dues, condominium fees and utilities.
Item 43 -Transportation
Combine your monthly lease, purchase or loan
payment, your average monthly costs for insurance,
licenses, registration fees, inspections, normal
repairs and maintenance, fuel, parking and tolls or
your average monthly public transportation
expenses you pay for bus, train and taxi fares and
any other mass transit fares.
Item 44 - Health Insurance
Enter your monthly expense for health insurance.
Item 46 - Court Ordered Payments
Includes child support, alimony, etc.
Item 49 - Other Expenses (Specify)
Food, Clothing & Miscellaneous - Enter the total
amount for this item.
Out-of-Pocket Health Care Costs - Enter the amount
paid each month.
Certification for Signature Line on Page 4
This requires the taxpayer's signature. For joint
income tax liabilities, both husband and wife must
sign the statement.
If you do not complete the form, we will not be able
to help determine the best method for you to pay
the amount due. This may result in significant delay
in account resolution.
You should also include copies of any agreement
that you have with the Internal Revenue Service,
showing amount of debt.
Provide any other additional information that
pertains to the settlement of your tax debt.
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Parent category: Financial