Form 14457 - Offshore Voluntary Disclosure Letter Page 2
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b. If “Yes,” were copies of those documents provided to the Attorney General of the United States as required by 18 USC §3506?
Taxpayer
Yes
No
Spouse
Yes
No
7. Disclose if you or any related entities currently under audit or criminal investigation by the Internal Revenue Service or any other law
enforcement authority?
a. Has the IRS notified you, your spouse or any related entities that it intends to commence an examination or investigation?
Taxpayer
Yes
No
Spouse
Yes
No
Related entities
Yes
No
b. Are you, your spouse or any related entities under criminal investigation by any law enforcement authority?
Taxpayer
Yes
No
Spouse
Yes
No
Related entities
Yes
No
c. If “Yes,” explain.
8. Do you believe that the IRS has obtained information concerning your tax liability?
Yes
No
If “Yes,” specify.
9. During the disclosure period, have you taken a position that you were a bona fide resident of a U.S. territory
Yes
No
(e.g., American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, or the U.S.
Virgin Islands) or did you file an income tax return with a U.S. territory?
If “Yes,” list the territory and tax years.
10. Please check the box to estimate the annual range of the highest aggregate value of your offshore accounts.
Tax Year
Tax Year
Tax Year
Tax Year
Tax Year
Tax Year
Tax Year
Tax Year
Highest Aggregate
Account/Asset Value
$0 to $100,000
$100,000 to $1,000,000
$1,000,000 to $2,500,000
$2,500,000 to $10,000,000
$10,000,000 to $100,000,000
Greater than $100,000,000
a. Please list all of your accounts
(attach additional sheets, if necessary)
14457
Catalog Number 61637F
Form
(Rev. 11-2017)
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