Form 656-B - Offer In Compromise Booklet Page 16
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32Page 8 of 8
In the past 3 years have you transferred any real property (land, house, etc.)?
Yes
No
If yes, list the type of property, value, and date of the transfer.
Have you lived outside the U.S. for 6 months or longer in the past 10 years?
Yes
No
Do you have any assets or own any real property outside the U.S.?
Yes
No
If yes, provide description, location, and value.
Do you have any funds being held in trust by a third party?
Yes
No
If yes, how much $
Where:
Section 10
Signatures
Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it
is true, correct, and complete.
►
Signature of Taxpayer
Date (mm/dd/yyyy)
►
Signature of Spouse
Date (mm/dd/yyyy)
Remember to include all applicable attachments listed below.
Copies of the most recent pay stub, earnings statement, etc., from each employer
Copies of the most recent statement for each investment and retirement account
Copies of the most recent statement, etc., from all other sources of income such as pensions, Social Security, rental income,
interest and dividends (including any received from a related partnership, corporation, LLC, LLP, etc.), court order for child
support, alimony, and rent subsidies
Copies of bank statements for the three most recent months
Copies of the most recent statement from lender(s) on loans such as mortgages, second mortgages, vehicles, etc., showing
monthly payments, loan payoffs, and balances
List of Notes Receivable, if applicable
Verification of delinquent State/Local Tax Liability, if applicable
Documentation to support any special circumstances described in the “Explanation of Circumstances” on Form 656, if applicable
Attach a Form 2848, Power of Attorney, if you would like your attorney, CPA, or enrolled agent to represent you and you do not
have a current form on file with the IRS.
Completed and signed Form 656
433-A (OIC)
Form
(Rev. 3-2017)
Catalog Number 55896Q
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