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.
we sent you). Generally, you may have up to 24
Line 4
months to pay. However, it is better to pay the
Even if you cannot pay the full amount you owe
amount you owe as soon as you can to reduce the
now, pay as much as possible to lower the amount
amount of interest you will pay.
of penalty and interest you will be assessed.
NOTE: A payment plan for business taxes is
If you are requesting this payment agreement at the
requested on form TC-804B.
same time you are filing your return, attach this form
to the front of the return and make the payment with
Bankruptcy
If you are in bankruptcy do not use this form.
your return. The instructions for your tax return will
Instead, call 801-297-6219 or if you are out of the
tell you how to make the payment.
Salt Lake area 1-800-662-4335 extension 6219.
If you are filing this form by itself, such as in
How Does the Agreement Process Work?
response to a billing notice, include a check or
If your request is approved, we will send you a
money order payable to the Utah State Tax
letter. The letter will confirm your monthly payment
Commission.
Do not send cash.
Be sure to include
amount and the number of required payments. It will
on your check or money order your name, address,
also explain how to make your first payment. You
and type of return and tax year (example: “TC-40,
will have the following payment options:
2011”).
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
3. Pay by Internet at
taxexpress.utah.gov.
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 (MasterCard, American
Express and Discover Card). 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 liabilities
.
Signatures
This means that you must have enough withholding
If you are filing a request for a joint filed return, the
or prepayments so that your future tax liability is
signatures of both taxpayers are required.
paid in full when you file a timely return.
Submit to:
Utah State Tax Commission
Any future year refunds due you from the Internal
210 N 1950 W
Revenue Service or the State will be applied
SLC, UT 84134-7000
against the amount you owe.
or fax to: 801-297-6202
Important Note
: Failure to make your payments on
time or failure to file and/or pay future returns when
due, will break your payment agreement. If you
break the agreement we can take action to collect
the tax you owe in full and place liens on your real
and tangible personal property.
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