State or Local Law Enforcement Application
for Reimbursement for Original Information
General Information
1)
This application is voluntary and the information requested enables us to determine and pay reimbursements.
2)
Not providing the information requested may result in the suspension of the processing of this application.
3)
Our authority for asking for the information on this form is derived from 26 U.S.C. 7624.
4)
No reimbursement shall be paid to you in any case where the taxes recovered total less than $50,000.
5)
The term ''taxes recovered'' means additional taxes, penalties, and additions to tax collected with respect to
illegal drug-related activities (or money laundering in connection with such activities), but not additional interest
or criminal fines that may be collected.
6)
The amount of the reimbursement payable is at the discretion of the IRS District Director or Service Center
Director and shall be equal to the cost incurred in your investigation of the taxpayer (including but not limited to
reasonable expenses, per diem, salary, and overtime) but not to exceed 10 percent of the sum recovered.
No reimbursement will be made for expenses incurred in the investigation of a taxpayer which have been
7)
reimbursed under any other program or arrangement including, but not limited to, Federal or state equitable
sharing arrangements.
The reimbursement will be paid after collection from the taxpayer and after the expiration of the applicable period
8)
of limitations for filing a claim for refund by the taxpayer, unless adequate indemnification is provided.
Instructions
1)
Submit this application to the Chief, Criminal Investigation Division of the Internal Revenue Service District in
which the taxpayer is located as soon as practicable after submitting the information but not later than 30 days
after the Service notifies you of the amount of taxes recovered as a result of the information submitted.
2)
Include all of the information which you provided to the IRS. For an agency to be eligible for a reimbursement, the
information provided must have substantially contributed to the recovery of the tax.
Form 211A
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