Form Otr-10 - Application For Wage Earners, Self-Employed Individuals, And Business
ADVERTISEMENT
1
2OFFER IN COMPROMISE
OTR‐10
Application For Wage Earners, Self‐Employed
FORM
OFFER IN COMPROMISE
Individuals, and Businesses
OFFICE OF TAX AND REVENUE
1a. Full Name of Taxpayer and Spouse (if applicable)
1c. Home Phone
1d. Cell Phone
( ) ______________________
( ) ________________________
_______________________________________________________________
1b. Mailing Address (Street, City, State, Zip Code)
1e. Business Phone
1f. Business Cell Phone
( ) ______________________
( ) ________________________
_______________________________________________________________
2a. Marital Status: Married Unmarried (Single, Divorced or Widowed)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
2b. Name, Age, and relationship of dependant(s)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
3a. Names and Social Security Numbers of all persons submitting this offer
3b. Business Tax Number(s), included with this offer
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
3c. Other Business Tax Number(s) not included with this offer
_______________________________________________________________
______________________________________________________________
4a. I/We (Individual Tax Type Taxpayers) submit this offer to compromise the
4b. I/We (Business Tax Type Taxpayers) submit this offer to compromise the
tax liabilities plus any interest, penalties, additions to tax, and additional
tax liabilities plus any interest, penalties, additions to tax, and additional
amounts required by law (tax liability) for the tax type and period below:
amounts required by law (tax liability) for the tax type and period below:
Individual Income Tax
Sales & Use
Tax Period(s) : ____________________________________________________
Withholding Tax
________________________________________________________________
Other Tax(es)/Fee(s)
________________________________________________________________
Please Specify Tax Period(s):
________________________________________________________________
________________________________________________________________
5. I/We submit this offer for the reason(s) checked below:
6. I/We offer to pay the following:
Doubt as to Liability ‐ If you believe you don’t owe the amount due, you
Lump Sum – 100% ‐ $ ______________________
must include with a Form OTR‐10 a detailed explanation of the reason(s)
you believe you don’t owe the tax.
6b. I/We offer to pay using the following terms:
Insufficient Resources ‐ If you don’t have enough assets or income to pay
the full amount, you must include with Form OTR‐10 a complete financial
Periodic Payment – 20% initial payment ‐ $ _____________________
statement, Form PA‐1 for individuals and/or PA‐2 for businesses.
Other proposed payment terms – 20% initial payment
Economic or Other Hardship ‐ If you have enough assets to pay the full
$ _____________________
amount, but believe that because of your exceptional circumstances
requiring full payment would cause an economic hardship or would be
Please specify: __________________________________________________
unfair and inequitable, you must include with Form OTR‐10 a complete
financial statement, Form PA‐1 and/or PA‐2.
_______________________________________________________________
7. Explanation of Circumstances ‐ I am requesting an offer in compromise for the reason(s) listed below:
1 1 0 1 4 t h S t r e e t , S . W . S u i t e 2 7 0 W , W a s h i n g t o n , D C 2 0 0 2 4 ‐ ( 2 0 2 ) 7 2 7 ‐ 4 T A X ( 4 8 2 9 )
Page 10
w w w . t a x p a y e r s e r v i c e c e n t e r . c o m
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 4361 - Application For Exemption From Self-employment Tax For Use By Ministers, Members Of Religious Orders And Christian Science Practitioners
Financial
Form 4361 - Application For Exemption From Self-employment Tax For Use By Ministers, Members Of Religious Orders And Christian Science Practitioners
Financial
Form 4361 - Application For Exemption From Self-employment Tax For Use By Ministers, Members Of Religious Orders And Christian Science Practitioners
Financial
Form 4361 - Application For Exemption From Self-employment Tax For Use By Ministers, Members Of Religious Orders And Christian Science Practitioners
Financial
Form Otr-308 - Application For Specific Exemption From D.c. Sales And Use Tax - Government Of The District Of Columbia
Financial
Related Categories
Parent category: Financial