Form 12277 - Application For Withdrawal Of Filed Form 668(Y), Notice Of Federal Tax Lien Page 2
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General Instructions
1. Complete the application. If the information you supply is
a. If a determination is made to withdraw the NFTL, we
not complete, it may be necessary for the IRS to obtain
will file a Form 10916(c), Withdrawal of Filed Notice of
additional information before making a determination on the
Federal Tax Lien, in the recording office where the
application.
original NFTL was filed and provide you a copy of the
document for your records.
Sections 1 and 2: Enter the taxpayer's name and
b. If the determination is made to not withdraw the
Social Security Number (SSN) or Employer
NFTL, we will notify you and provide information
Identification Number (EIN) as shown on the Notice of
regarding your rights to appeal the decision.
Federal Tax Lien (NFTL).
4. At your request, we will notify other interested parties
Section 3: Enter the name of the person completing
of the withdrawal notice. Your request must be in
the application if it differs from the taxpayer's name in
writing and provide the names and addresses of the
section 1 (for example, taxpayer representative). For
credit reporting agencies, financial institutions, and/or
business taxpayers, enter the name and title of person
creditors that you want notified.
making the application. Otherwise, leave blank.
NOTE: Your request serves as our authority to release the
Sections 4 through 8: Enter current contact information
notice of withdrawal information to the agencies, financial
of taxpayer or representative.
institutions, or creditors you have identified.
Section 9: Attach a copy of the NFTL to be withdrawn,
5. If, at a later date, additional copies of the withdrawal notice
if available. If you don't have a copy of the NFTL but
are needed, you must provide a written request to the
have other information about the NFTL, enter that
Advisory Group Manager. The request must provide:
information to assist the IRS in processing your
request.
a. The taxpayer's name, current address, and taxpayer
identification number with a brief statement
Section 10: Check the box that indicates the current
authorizing the additional notifications;.
status of the lien.
b. A copy of the notice of withdrawal, if available; and
"Open" means there is still a balance owed with
c. A supplemental list of the names and addresses of
respect to the tax liabilities listed on the NFTL.
any credit reporting agencies, financial institutions, or
"Released" means the lien has been satisfied or is no
creditors to notify of the withdrawal of the filed Form
longer enforceable.
668(Y).
"Unknown" means you do not know the current status
of the lien.
.
Privacy Act Notice
Section 11: Check the box(es) that best describe the
reason(s) for the withdrawal request. NOTE: If you are
We ask for the information on this form to carry out the
requesting a withdrawal of a released NFTL, you
Internal Revenue laws of the United States. The primary
generally should check the last box regarding the best
purpose of this form is to apply for withdrawal of a notice of
interest provision.
federal tax lien. The information requested on this form is
needed to process your application and to determine
Section 12: Provide a detailed explanation of the
whether the notice of federal tax lien can be withdrawn.
events or the situation to support your reason(s) for the
You are not required to apply for a withdrawal; however, if
withdrawal request. Attach additional sheets and
you want the notice of federal tax lien to be withdrawn, you
supporting documentation, as needed.
are required to provide the information requested on this
form. Sections 6001, 6011, and 6323 of the Internal
Affirmation: Sign and date the application. If you are
Revenue Code authorize us to collect this information.
completing the application for a business taxpayer,
Section 6109 requires you to provide the requested
enter your title in the business.
identification numbers. Failure to provide this information
may delay or prevent processing your application; providing
2. Mail your application to the IRS office assigned your
false or fraudulent information may subject you to penalties.
account. If the account is not assigned or you are
uncertain where it is assigned, mail your application to IRS,
Routine uses of this information include giving it to the
ATTN: Advisory Group Manager, in the area where you live
Department of Justice for civil and criminal litigation, and to
or is the taxpayer's principal place of business. Use
cities, states, the District of Columbia, and U.S.
Publication 4235, Advisory Group Addresses, to determine
commonwealths and possessions for use in administering
the appropriate office.
their tax laws. We may also disclose this information to
other countries under a tax treaty, to federal and state
agencies to enforce federal nontax criminal laws, or to
3. Your application will be reviewed and, if needed, you may
be asked to provide additional information. You will be
federal law enforcement and intelligence agencies to
contacted regarding a determination on your application.
combat terrorism.
12277
Catalog Number 27939C
Form
(Rev. 10-2011)
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