Form 870 - Waiver Of Restrictions On Assessment And Collection Of Deficiency In Tax And Acceptance Of Overassessment

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Department of the Treasury—Internal Revenue Service

Date received by

870

Internal Revenue Service

Form

Waiver of Restrictions on Assessment and Collection of

(Rev. March 1992)

Deficiency in Tax and Acceptance of Overassessment

Names and address of taxpayers (Number, street, city or town, State, ZIP code)

Social security or employer

identification number

Increase (Decrease) in Tax and Penalties

Tax year ended

Tax

Penalties

(For instructions, see back of form)

Consent to Assessment and Collection

I consent to the immediate assessment and collection of any deficiencies (increase in tax and penalties) and accept any overassessment (decrease in

tax and penalties) shown above, plus any interest provided by law. I understand that by signing this waiver, I will not be able to contest these years in

the United States Tax Court, unless additional deficiencies are determined for these years.

Date

YOUR

SIGNATURE

HERE

Date

SPOUSE'S

SIGNATURE

Date

TAXPAYER'S

REPRESENTATIVE

HERE