Form 211 - Application For Award For Original Information
Download a blank fillable Form 211 - Application For Award For Original Information in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 211 - Application For Award For Original Information with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB No. 1545-0409
Department of the Treasury - Internal Revenue Service
Form 211
Date Claim Received:
Application for Award for
(Rev. December 2007)
Original Information
Claim No. (completed by IRS)
3. Claimant's SSN or ITIN
2. Claimant's Date of Birth
1. Name of individual claimant
Month
Day
Year
5. Spouse's Date of Birth
6. Spouse's SSN or ITIN
4. Name of spouse
(if applicable)
Month
Day
Year
7. Address of claimant, including zip code, and telephone number
8. Name & Title of IRS employee to whom violation was reported
9. Date violation reported:
11. Taxpayer Identification Number(s) (e.g.,
10. Name of taxpayer (include aliases) and any related taxpayers who committed the violation:
SSN, ITIN, or EIN):
12. Taxpayer's address, including zip code:
13. Taxpayer's date of birth or approximate
age:
14. State the facts pertinent to the alleged violation. (Attach a detailed explanation and all supporting information in your possession
and describe the availability and location of any additional supporting information not in your possession.) Explain why you believe the
act described constitutes a violation of the tax laws.
15. Describe how you learned about and/or obtained the information that supports this claim and describe your present or former
relationship to the alleged noncompliant taxpayer(s). (Attach sheet if needed.)
16. Describe the amount owed by the taxpayer(s). Please provide a summary of the information you have that supports your claim as
to the amount owed. (Attach sheet if needed.)
Declaration under Penalty of Perjury
I declare under penalty of perjury that I have examined this application, my accompanying statement, and supporting documentation
and aver that such application is true, correct, and complete, to the best of my knowledge.
18. Date
17. Signature of Claimant
MAIL THE COMPLETED FORM TO THE ADDRESS SHOWN ON THE BACK
211
Form
(Rev. 12-2007)
Catalog Number 16571S
publish.no.irs.gov
Department of the Treasury-Internal Revenue Service
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial