OFFER IN COMPROMISE
Doubt as to liability Doubt as to Collectibility Special Circumstances
Note: If you are requesting compromise based on doubt as to liability, explain why you don’t believe you owe the tax. If you believe special circumstances exist
that is affecting your ability to fully pay the amount of tax due, please explain. You may attach additional sheets if necessary.
8. Under penalties of perjury, I/We declare that I/we have examined this offer, including accompanying scheduled and statements, and to the best of my/our
knowledge and belief, the information provided is true, correct, and complete.
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Signature of Taxpayer proponent Date
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Signature of Taxpayer proponent Date
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Signature of Taxpayer proponent Date
FOR INTERNAL USE ONLY
Proposed Offer in Compromise
Reason for approval/denial:
Accepted Rejected
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Signature and Title of OTR Official
Date
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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 )
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