Virginia Offer In Compromise Business Request For Settlement printable pdf download

Virginia Offer In Compromise Business Request For Settlement

Commonwealth of Virginia

Department of Taxation

Offer In Compromise

Business Request For Settlement

Name Of Business

FEIN

Address Of Business

Va. Account No.

Telephone No.

T/A Name, If Different

To: Tax Commissioner

I/We submit this offer to settle tax, interest, and penalties for the periods indicated below.

Sales Tax For The Period(s):

Withholding Tax For The Period(s):

Corporate Tax For The Period(s):

Other (Specify) For The Period(s):

I/We Offer To Pay $

Payment Attached

If you are unable to enclose the full amount offered, state when the full payment

will be received. (Ex.: within ten (10) days from the date the offer is accepted.)

I/We submit this offer for the reason checked below:

Doubt As To Collectibility. My financial statement is attached.

Doubt As To Liability. My detailed explanation is attached.

Request For Waiver Of Penalty Due To Reasonable Cause. My detailed explanation is attached.

*See following page for terms and conditions.

I/We, the undersigned, declare that I/we have examined this offer, including accompanying schedules and statements, and to

the best of my/our knowledge, it is true, accurate, and complete. I/We hereby grant the power of attorney to act for me/us to

compromise the above referenced liability(ies) to

. Also, I/we grant

authorization to verify any financial data by use of a credit report.

Signature of Taxpayer(s)

Date:

Daytime Phone:

Signature of Taxpayer's Representative

Date:

Daytime Phone:

Virginia Offer In Compromise Business Request For Settlement