Form Dtf-383 - Income Tax Installment Payment Agreement Request - 2000
ADVERTISEMENT
1New York State Department of Taxation and Finance
DTF-383
Income Tax Installment
Payment Agreement Request
•
Attach to the front of your 2000 New York State income tax return.
Complete this request form only if you cannot pay the full amount of income tax you owe as shown on your
2000 New York State income tax return. The Tax Department will consider your request based upon the
information you provide below, and notify you whether your request is approved or denied.
(See instructions on back.)
Daytime telephone number
Evening telephone number
Your social security number
Spouse’s social security number
(if joint return)
(
)
(
)
Please enter your first name first. For a joint return, use both name lines.
AM
Your first name and middle initial
Your last name
(for a joint return, enter spouse’s name on line below)
When is the best time to phone you? _________
PM
Spouse’s first name and middle initial
Spouse’s last name
Financial information:
Bank/credit union:
savings
checking
Mailing address
Apartment number
(number and street or rural route)
The department will arrange a direct payment account with your
bank. Authorization forms for this purpose will be mailed to you
after your payment plan is established.
City, village, or post office
State
ZIP code
Name of bank/credit union
In the space below, print or type your permanent home address if it is not the same
as your mailing address above.
Address
Permanent home address
Apartment number
(number and street or rural route)
City
State
ZIP code
City, village, or post office
State
ZIP code
Bank/credit union:
savings
checking
Name of bank/credit union
Employment information:
$
.
Your gross monthly salary ..........................
Address
Your employer’s name
City
State
ZIP code
Employer’s address
Monthly expenses:
City
State
ZIP code
Rent ............ $
Child support .... $
Mortgage .......
Utilities .............
$
.
Your spouse’s gross monthly salary
...
(if joint return)
Food ..............
Transportation ....
Insurance ......
Credit cards .....
Your spouse’s employer’s name
*
IRS
.............
Auto loan ** .....
**
Alimony .........
I own my car
Employer’s address
**
I lease my car
*
If you would like us to set
up a payment agreement
Number of dependents
for your IRS liability,
City
State
ZIP code
check here
...
(see instructions)
If you have any wage garnishments (child support, IRS,
Attach this completed
.
sheriff, etc.), what is the total amount that you owe? ..... $
Form DTF-383 and your initial
If you are currently unemployed or temporarily laid off (receiving
payment to the front of your 2000
unemployment, social security, seasonal layoff, etc.), check this box .......
income tax return, and send it to the
Please write below your reason(s) for requesting a payment agreement:
Tax Department. We will notify you
whether your request is approved or
denied.
•
.
Based on the information you provided above, what amount can you pay each month? .............................. $
•
How many months do you feel you would need (circle one):
3
4
5
6
7
8
9
10 11 12 13-24 months.
Your signature
Date
Spouse’s signature
Date
(if joint return)
To request a payment agreement of more than 24 months or to discuss an existing payment agreement,
please contact the Tax Department at 1 800 835-3554.
381094
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial