Form 14135 - Application For Certificate Of Discharge Of Property From Federal Tax Lien
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1
2
3Department of the Treasury — Internal Revenue Service
14135
Form
Application for Certificate of Discharge of
OMB No. 1545-2174
(June 2010)
Property from Federal Tax Lien
Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be
included as necessary. Additional information may be requested of you or a third party to clarify the details of the
transaction(s).
:
1. Taxpayer Information
(Individual or Business named on the notice of lien)
Name
or
as it appears on lien
Primary Social Security Number
(Individual First, Middle Initial, Last)
(Business)
(last 4 digits only)
Name Continuation
or
Secondary Social Security Number
(Individual First, Middle Initial, Last)
(Business d/b/a)
(last 4 digits only)
Address
Employer Identification Number
(Number, Street, P.O. Box)
City
State
ZIP Code
Fax Number
Telephone Number
(with area code)
(with area code)
Check if also the Taxpayer
2. Applicant Information:
(If not the taxpayer, attach copy of lien. See Sec.10)
Name
Relationship to taxpayer
(First, Middle Initial, Last)
Address
(Number, Street, P.O. Box)
City
State
ZIP Code
Telephone Number
Fax Number
(with area code)
(with area code)
Check if also the Applicant
3. Purchase/Transferee/New Owner
Relationship to taxpayer
Attached: Form 8821 or
Yes
No
4. Attorney/Representative Information
Power of Attorney Form 2848
Name
Interest Represented
(First, Middle Initial, Last)
(e.g. taxpayer, lender, etc.)
Address
(Number, Street, P.O. Box)
State
City
ZIP Code
Telephone Number
Fax Number
(with area code)
(with area code)
5. Lender/Finance Company Information - or
(Settlement/Escrow Company for applications under Section 6325(b)(3) only)
Company Name
Contact Name
Contact Phone Number
Catalog Number 54727S
Form
14135
(Rev. 06-2010)
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