Form 656-B - Offer In Compromise Booklet Page 22
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32Page 6 of 6
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.
Has the business been located 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, please provide description, location, and value.
Does the business have any funds being held in trust by a third party?
Yes
No
If yes, how much $
Where:
Does the business have any lines of credit?
If yes, credit limit $
Amount owed $
Yes
No
What property secures the line of credit?
Section 7
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
Title
Date
(mm/dd/yyyy)
Remember to include all applicable attachments from list below.
A current Profit and Loss statement covering at least the most recent 6–12 month period, if appropriate.
Copies of the three most recent statements for each bank, investment, and retirement account
If an asset is used as collateral on a loan, include copies of the most recent statement from lender(s) on loans, monthly
payments, loan payoffs, and balances.
Copies of the most recent statement of outstanding notes receivable.
Copies of the most recent statements from lenders on loans, mortgages (including second mortgages), monthly payments, loan
payoffs, and balances.
Copies of relevant supporting documentation of the 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. Make sure the current tax year is included.
Completed and signed Form 656
433-B (OIC)
Form
(Rev. 3-2017)
Catalog Number 55897B
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