Form 14134 - Application For Certificate Of Subordination Of Federal Tax Lien
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3Department of the Treasury — Internal Revenue Service
14134
Application for Certificate of Subordination of
Form
OMB No. 1545-2174
(June 2010)
Federal Tax Lien
Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be included as
necessary. Additional information may be requested to clarify the details of the transaction(s).
1. Taxpayer Information
(Individual or Business named on the notice of lien)
Name
or
as it appears on lien
Primary Social Security Number
(Individual First, Middle Initial, Last)
(Business)
(last 4 digits only)
Name Continuation
or
Secondary Social Security Number
(Individual First, Middle Initial, Last)
(Business d/b/a)
(last 4 digits only)
Address
Employer Identification Number
(Number, Street, P.O. Box)
City
State
ZIP Code
Telephone Number
(with area code)
Fax Number
(with area code)
2. Applicant Information
Check if also the Taxpayer
(If not the taxpayer, attach copy of lien. See Sec.10)
Name
Relationship to taxpayer
(First, Middle Initial, Last)
Address
(Number, Street, P.O. Box)
City
State
ZIP Code
Telephone Number
Fax Number
(with area code)
(with area code)
3. Property Owner
Check if also the Applicant
Relationship to Taxpayer
Attached: Form 8821 or
4. Attorney/Representative Information
Yes
No
Power of Attorney Form 2848
Name
Interest Represented
(First, Middle Initial, Last)
(e.g. taxpayer, lender, etc.)
Address
(Number, Street, P.O. Box)
State
City
ZIP Code
Telephone Number
Fax Number
(with area code)
(with area code)
5. Lending/Finance Company
Company Name
Contact Name
Contact Phone Number
Type of transaction
(For example, loan consolidation, refinance, etc)
14134
Catalog Number 54726H
Form
(Rev. 06-2010)
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