Department of the Treasury - Internal Revenue Service
866
Form
Agreement as to Final Determination of Tax Liability
(Rev. July 1981)
(Complete three copies of this form)
Under Section 7121 of the Internal Revenue Code,
(Taxpayer's name, address, and identifying number)
and the Commissioner of Internal Revenue agree that the liability of the above taxpayer for the taxable periods and kinds of tax listed in this agreement is as
follows: (The applicability or inapplicability of interest or penalties, including additions to tax or additional amounts authorized by Subchapter A of Chapter 68 of
the Code, is not determined except as provided in this agreement.)
Chapter Number and
Total Tax
Subchapter Letter of
Liability
Taxable
Kind of Tax
Internal Revenue Code
for Period
Period
or Penalty
This agreement is final and conclusive except:
(1) the liability it relates to may be reopened in the event of fraud, malfeasance, or misrepresentation of material fact and
(2) it is subject to the Internal Revenue Code sections that expressly provide that effect be given to their provisions notwithstanding any other law or
rule of law except Code section 7122.
By signing this agreement, the above parties certify they have read and agreed to its terms.
Your signature
Date signed
Spouse's signature (If a joint return was filed)
Date signed
Signature of taxpayer's representative
Date signed
Taxpayer (other than individual)
By
Date signed
Title
Commissioner of Internal Revenue
By
Date signed
Title
Cat. No. 16889B
866
Part 1 – Original
(See back)
Form
(Rev. 7-81)