Form 12a200 (11-12) - Kentucky Individual Income Tax Installment Agreement Request Page 2
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1
2INDIVIDUAL INCOME TAX
INSTALLMENT AGREEMENT REQUEST
GENERAL INFORMATION
A Kentucky taxpayer has the right to consideration of an
Income Tax Installment Agreement Request, and
installment agreement for the payment of delinquent
attach an original Form 12A200 to the front of the
taxes, interest, penalties and fees. The right to an
return. This form is color coded for easy recognition
installment agreement is provided for in KRS 131.081(9)
during processing. Copies will delay processing and
and is primarily dependent on the taxpayer’s inability
may result in additional penalties and interest. The
to pay the amount due in full.
Department of Revenue will make every effort to
acknowledge the request within 90 days. If you do not
Eligibility for an Installment Agreement
receive a response to this request within 90 days from
the date you file your return, please call the Division of
An installment agreement should be requested only
Collections, (502) 564-4921, ext. 5354.
when there is no other way of paying the liability on
time.
State Tax Lien
A taxpayer must clearly demonstrate an inability to pay
Depending on the amount and length of the agreement,
the liability in full and the agreement must facilitate
a State Tax Lien may be filed. If a lien is filed, it will
collection. Generally this means that taxpayers who
remain on the taxpayer’s credit record for up to
have the ability to pay with available funds or borrow
seven years after the liability is paid and the lien is
from a financial institution are not eligible.
released.
Proposed Monthly Payment Amount
Making Payment
The monthly payment amount will be based upon the
Interest, penalties and fees may be reduced by making
taxpayer’s ability to pay after considering the taxpayer’s
a partial payment with the return or making payments
monthly income and reasonable expenses. Allowable
prior to obtaining a payment agreement. When making
expenses generally include reasonable amounts for
payments, please include the taxpayer’s name(s),
food, clothing, housing (and associated expenses),
Social Security number(s), tax period and the type
installment payments and other necessary living
tax being paid. Checks should be made payable to the
expenses. The proposed monthly payment amount
Kentucky State Treasurer and mailed to the Division
should be as much as possible to minimize the length
of Collections at the address below. For ACH Debits
of the agreement and the accrual of interest, penalties
(automatic electronic withdrawals from a checking
and fees.
account) or credit card payments, see Form 12A200.
Interest, Penalties, Fees and Refund Offsets
Assistance
The law provides for the assessment of interest,
Questions should be directed to:
penalties and fees for tax liabilities paid after the
due date. Interest accrues at the tax interest rate (6
Division of Collections
percent for 2013). In addition, penalties of 2 percent
Kentucky Department of Revenue
per month may be assessed on the unpaid tax. A 25
P.O. Box 491
percent Cost of Collection Fee is imposed on tax due
Frankfort, KY 40602-0491
which becomes due and payable (generally 46 days
(502) 564-4921, ext. 5354
after the assessment date). Interest, penalties and fees
continue to accumulate while an installment agreement
Form 12A200, Individual Income Tax Installment
is in place. Also, any money Kentucky may owe you
Agreement Request, is available at Kentucky Taxpayer
(tax refunds, etc.) will be offset to your outstanding
Service Centers located throughout the commonwealth.
liability. Additionally, any federal income tax refund
Forms may also be obtained from the Internet at
that may become due to you may be offset to this
, or by contacting the Division of
liability pursuant to 26 USC §6402(e). Penalties and
Collections or:
fees may be waived or reduced if the taxpayer files the
return on time, honors the payment agreement and/or
FORMS
demonstrates reasonable cause.
Operations and Support Services Branches
Setting up the Agreement
Kentucky Department of Revenue
501 High Street
Taxpayers who believe they qualify for an installment
Frankfort, KY 40620
agreement should complete Form 12A200, Individual
(502) 564-3658
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