Form Mo-656 - Offer In Compromise Application
Download a blank fillable Form Mo-656 - Offer In Compromise Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Mo-656 - Offer In Compromise Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7Reset Page
Print Form
FORM
DOR USE ONLY
MISSOURI DEPARTMENT OF REVENUE
MO-656
TAXATION DIVISION
Date Received ______________________
OFFER IN COMPROMISE APPLICATION
Revenue Agent _____________________
(REV. 5-2012)
SECTION 1 PERSONAL INFORMATION
MI
LAST NAME
FIRST NAME
SOCIAL SECURITY NUMBER
DATE OF BIRTH
SPOUSE FIRST NAME
MI
SPOUSE SOCIAL SECURITY NUMBER
SPOUSE DATE OF BIRTH
SPOUSE LAST NAME
OTHER NAMES OR ALIASES USED
SPOUSE OTHER NAMES OR ALIASES USED
UNMARRIED
MARITAL STATUS
MARRIED
(SINGLE, DIVORCED, OR WIDOWED)
PROVIDE INFORMATION FOR ALL OTHER PERSONS IN THE HOUSEHOLD AND/OR CLAIMED AS A DEPENDENT. ATTACH ADDITIONAL PAGES AS NEEDED.
(THIS INFORMATION IS OPTIONAL IF OFFER IS BASED ON DOUBT AS TO LIABILITY OR EXCEPTIONAL CIRCUMSTANCES).
CLAIMED AS A DEPENDENT
CONTRIBUTES TO
NAME
AGE
RELATIONSHIP
ON YOUR FORM 1040?
HOUSEHOLD INCOME?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YOUR CURRENT STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
PHONE NUMBER
SECONDARY PHONE NUMBER
E-MAIL ADDRESS
YOUR MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP CODE
NAME OF YOUR TAX REPRESENTATIVE (CPA, ATTORNEY, ETC.) ATTACH POA FORM 2827
FAX NUMBER
PHONE NUMBER
TAX REPRESENTATIVE’S ADDRESS
CITY
STATE
ZIP CODE
I/WE SUBMIT THIS OFFER FOR THE REASON CHECKED BELOW: SEE INSTRUCTIONS FOR EXPLANATION OF REASONS. (CHECK ONE)
DOUBT AS TO LIABILITY
DOUBT AS TO COLLECTIBILITY
SEVERE ECONOMIC HARDSHIP
EXCEPTIONAL CIRCUMSTANCES
SECTION 2 PAYOFF INFORMATION
TAX TYPE
SSN OR BUSINESS IDENTIFICATION NUMBER
TAX PERIODS
PERSONAL INCOME TAX
BUSINESS TAX (WITHHOLDING, SALES, USE, CORPORATE)
OTHER (EXPLAIN)
I/WE OFFER TO PAY $ _________________________________. (MUST BE MORE THAN ZERO IF OFFER IS DUE TO DOUBT AS TO COLLECTIBILITY)
CHECK ONE OF THE FOLLOWING:
CASH OFFER
BALANCE TO BE PAID IN:
10 DAYS
30 DAYS
SHORT-TERM DEFERRED PAYMENT OFFER (MONTHLY PAYMENTS BEGINNING WITHIN 30 DAYS OF ACCEPTANCE OF THE OFFER)
$ ____________________ WITHIN 30 DAYS
$ ____________________ ON THE ____________________ DAY OF EACH MONTH STARTING THE SECOND MONTH AFTER WRITTEN NOTICE OF
ACCEPTANCE OF THE OFFER FOR A TOTAL OF ____________________ MONTHS.
WILL YOU BORROW THE SETTLEMENT OFFER AMOUNT?
YES
NO
IF YES, PROVIDE THE LENDER’S NAME, ADDRESS, PHONE; LIST ALL COLLATERAL, IF ANY, PLEDGED TO SECURE THE LOAN.
LENDER INFORMATION
NAME
PHONE NUMBER
IS LENDER A MEMBER OF YOUR HOUSEHOLD
OR IMMEDIATE FAMILY?
(
)
YES
NO
MAILING ADDRESS
ZIP
CITY
STATE
COLLATERAL
MO-656 (5-2012)
6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial