Form 14773 - Offer In Compromise Withdrawal

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Department of the Treasury - Internal Revenue Service
Offer in Compromise Withdrawal
(December 2017)
Offer number
Taxpayer Identification Number
(last 4 digits)
To whom it may concern:
I hereby withdraw my Offer in Compromise (OIC) dated
. I understand that by withdrawing this OIC, I waive
my appeal rights.
Name (printed)
Please complete this section if you submitted a deposit with the OIC. (This does not include the non-refundable
application fee you paid.) (If you need additional space, attach a separate sheet.)
Amount of Deposit $
Check one
I wish to have my OIC deposit refunded to me.
I consent to the application against my outstanding tax liability, as shown below, of the above amount deposited on
my OIC.
Taxpayer ID Number
Type of Tax
Amount to be Applied
(last 4 digits)
Sign here to acknowledge application of deposit
Catalog Number 68986V
(Rev. 12-2017)


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Parent category: Financial