Form 872-T - Notice Of Termination Of Special Consent To Extend The Time To Assess Tax
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1Department of the Treasury-Internal Revenue Service
In reply refer to
872-T
Form
Notice of Termination of Special Consent to
(Rev. July 2003)
Extend the Time to Assess Tax
Taxpayer(s) Name(s)
Termination by
Taxpayer
Internal Revenue Service
Taxpayer(s) Address
Taxpayer Identification Number
Office where
Form 872-A/Form 872-IA
Originated
Kind of Tax
Tax Period(s) Covered by this Notice
IRS Center Where Return Filed
This form is written notification of termination of:
(Check the appropriate box)
Form 872-A, Special Consent to Extend the Time to Assess Tax
Form 872-IA, Special Consent to Extend the Time to Assess Tax As Well As Tax Attributable to Items of a Partnership
for the kind of tax and tax period(s) indicated above. This notice of termination of consent is provided under the terms of the agreement
.
between the taxpayer(s) named above the Commissioner of Internal Revenue dated
See the back of this form for signature instructions.
Please note that signing this notice may alter the taxpayer(s) appeal rights.
YOUR SIGNATURE
(Date signed)
SPOUSE'S SIGNATURE
(Date signed)
TAXPAYER'S REPRESENTATIVE'S
SIGNATURE
(Date signed)
(You must also attach written authorization as stated in the instructions on the back of this
form)
CORPORATE NAME
(Name)
(Title)
(Date signed)
CORPORATE
OFFICER(S)
SIGNATURE
(Name)
(Date signed)
(Title)
(Authorized Official Signature and Title - see instructions)
INTERNAL REVENUE SERVICE SIGNATURE AND TITLE
(Division Executive Name - see instructions)
(Division Executive Title - see instructions)
BY
(Authorized Official Signature and Title - see instructions)
(Date signed)
872-T
(Instructions are on the 2nd page of this form)
Catalog Number 20775A
Form
(Rev. 7-2003)
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