Form Dtf-4 - Offer In Compromise For Liabilities Not Fixed And Final And Subject To Administrative Review

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New York State Department of Taxation and Finance
DTF-4
Offer in Compromise
(11/08)
For Liabilities Not Fixed and Final
and Subject to Administrative Review
Name of taxpayer(s) and/or trade or business names
Social security number(s)
Home address
Employer identification number (EIN)
Business address
Type of tax and entity:
income
individual
Employer
sales
partnership
withholding
corporation
Address
other
Taxpayer’s representative
Telephone number
Date
(
)
Address
Amount offered
$
(attach Form POA‑1, Power of Attorney)
Mark an X in the applicable box(es):
(see instructions on page 3)
Offer based on doubt as to liability
Offer based on doubt as to collectibility
1. Record of liabilities asserted and payments
(to be filled in by taxpayer)
For office use only
(Attach additional pages if needed.)
Notice or assessment
Total payments
Penalty and
Tax period
Amount of tax
Amount due
number (assessment I.D.)
to date
interest
$
Note: Submit a copy of all notices that are the subject of this offer.
Total
2a. The total sum of $
is offered in compromise.
No payment is required with the submission of an offer.
2b. If this offer in compromise is rejected:
Retain any amount submitted with this offer and credit it to liabilities.
Return any amount submitted with this offer.
3. Except for any amount referred to in paragraph 2(b) above, in making this offer, and as part of consideration,
it is agreed (a) that the commissioner of Taxation and Finance shall keep all payments, sums collected
and other credits made to the liabilities asserted for the periods covered by this offer, and (b) that the
commissioner shall keep any and all amounts to which the taxpayer(s) may be entitled under the Tax Law,
due through overpayments of any tax or other liability including interest and penalties, for periods ending before
or within or as of the end of the calendar year in which this offer is accepted (and which are not in excess of the
difference between the liability sought to be compromised and the amount offered). Any such refund received by
the taxpayer(s) after this offer is filed will be returned.

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