Form A-212 - Petition For Compromise Of Delinquent Taxes - Wisconsin Department Of Revenue Page 4
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418.
PETITIONER'S OFFER IN COMPROMISE
In accordance with Sections 71.92(3) and 77.62(1) of the Wisconsin Statutes, this petition is submitted by the undersigned who
declares under penalties of perjury that this petition, including accompanying schedules and statements, is true, correct and complete
to the best of his/her knowledge. The sum of $_______________ is being offered to compromise the delinquent tax liability set forth
in this petition.
It is understood that this offer does not provide relief from said liability until the offer is accepted in writing by the Department of
Revenue and paid within ten days from the date of such acceptance.
It is mutually agreed that if within three years from the date this offer is accepted, the petitioner has income or property sufficient
to enable him/her to pay the remainder of the tax including penalty and interest, the Department may reopen this matter and order
payment in full of such tax, penalty and interest.
As a part of the consideration for this offer, the petitioner waives any claims to overpayments of taxes to which he/she may be
entitled for any of the years prior to and including those involved in this compromise settlement when the overpayments are not in
excess of the difference between the liability sought to be compromised and the amount offered. This waiver is withdrawn if the total
amount of delinquent tax set forth in this petition is paid in full within three years from the date the offer is accepted.
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STATE OF
ss.
County of
, being first duly sworn on oath, deposes and says that he/she is the petitioner
named above (or an officer of the above-named petitioning corporation, to wit, its
, and that he/she is authorized
to make this sworn statement); that he/she has examined this petition and knows the facts contained therein are true to the best of
his/her knowledge.
Signature of petitioner (or corporate officer)
Subscribed and sworn to before me this
day of
, 19
Notary Public, State of
19.
COMPROMISE ORDER
On the basis of the sworn statement of the above-named petitioner, the Wisconsin Department of Revenue by its duly autho-
rized undersigned hereby finds:
That the petition for compromise is rejected.
Signature
Date
That the petitioner is able to pay the sum of $
in compromise of his/her delinquent tax liability which amounts
to $
. Therefore the petitioner's liability as set forth in this petition is reduced to $
provided
this sum is paid to the Wisconsin Department of Revenue,
, Wisconsin within ten days from the date this offer
was accepted.
Signature
Date
20.
LOCATIONS OF DISTRICT OFFICES
Appleton
Eau Claire
Madison
Milwaukee
265 W. Northland Ave.
718 Clairemont Ave.
P.O. Box 8910
819 N. Sixth St.
54913
54701
5005 University Avenue
Rm. 408
(414) 832-2727
(715) 836-2811
53708
53203
(608) 266-8329
(414) 227-4000
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