Form Tc-804 - Individual Income Tax Payment Agreement Request Page 2
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1
2Purpose of Form
Form Instructions
Use this form to request a monthly payment plan if
If you are making this request for a joint filed return,
you cannot pay the full amount you owe on your
enter the names and social security numbers in the
individual income tax return (or on a billing notice
same order as they appear on your tax return, your
we sent you). Generally, you may have up to 24
telephone numbers and email address.
months to pay. However, it is better to pay the
Line 3
amount you owe as soon as you can to reduce the
Enter any payment amount being paid with the
amount of interest you will pay.
return or billing notice. Pay as much as possible to
lower the amount of penalty and interest you will be
NOTE: A payment plan for business taxes is
assessed.
requested on form TC-804B.
Line 4
Bankruptcy
Enter the amount you can pay monthly. Even if you
If you are in bankruptcy do not use this form.
cannot pay the full amount you owe now, pay as
Instead, call 801-297-6219 or if you are out of the
much as possible each month to lower the amount
Salt Lake area 1-800-662-4335 extension 6219.
of penalty and interest you will be assessed.
How Does the Agreement Process Work?
If your request is approved, we will send you an
Late filing, late payment and extension penalties
email. The email will confirm your monthly payment
may apply. Interest will be assessed and continue
to accrue until the amount owed is paid in full.
amount and the number of required payments. It
will also explain how to make your first payment.
Penalty and interest information is available online
You will have the following payment options:
at
incometax.utah.gov
.
1. Pay by mail with check or money order.
Line 5
2. Pay in person at one of our offices.
Enter the day of the month you want the payment
taxexpress.utah.gov.
3. Pay by Internet at
due. This is the day the payment
must
be received
a. Electronic check (direct debit) from your
by the Tax Commission. Note: If you are mailing
checking or savings account.
your payment, allow 3 to 5 days for mail delivery.
b. Credit card (American Express Discover
,
Card
, MasterCard and Visa
). You will be
Line 6
charged a fee each time you use this
You must have filed a return for all prior years. List
method of payment. The fee is based on
the years for which you have not filed an income tax
a percentage of the payment made.
return. If you are unable to file a return due to lost
records you need to estimate your liability. Your
By approving your request we agree to let you pay
payment agreement will not be approved until all
the tax you owe in monthly payments instead of
returns have been filed. If you have questions
immediately paying the tax in full. In return you
contact us at 801-297-7703.
agree to make your monthly payments on time. You
also agree to
meet all of your future tax
Signatures
If you are filing a request for a joint filed return, the
liabilities
. This means that you must have enough
signatures of both taxpayers are required.
withholding or prepayments so that your future tax
liability is paid in full when you file a timely return.
Submit to:
Any future year refunds due you from the Internal
Utah State Tax Commission
Revenue Service or the State will be applied
210 N 1950 W
against the amount you owe.
SLC, UT 84134-7000
Important Note
: Failure to make your payments on
or fax form to: 801-297-6202
time or failure to file and/or pay future returns when
due, will break your payment agreement. If you
Email Address Note:
All communication on pay
break the agreement we can take action to collect
plan is by email. Include your email address where
the tax you owe in full and place liens on your real
indicated. The email address will be used to send
and tangible personal property.
you notice of approval and to remind you of your
pay plan.
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