Form 14773 - Offer In Compromise Withdrawal
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1Department of the Treasury - Internal Revenue Service
14773
Form
Offer in Compromise Withdrawal
(December 2017)
Offer number
Taxpayer Identification Number
(last 4 digits)
To whom it may concern:
I hereby withdraw my Offer in Compromise (OIC) dated
. I understand that by withdrawing this OIC, I waive
my appeal rights.
Signature
Name (printed)
Date
Please complete this section if you submitted a deposit with the OIC. (This does not include the non-refundable
application fee you paid.) (If you need additional space, attach a separate sheet.)
Amount of Deposit $
Check one
I wish to have my OIC deposit refunded to me.
I consent to the application against my outstanding tax liability, as shown below, of the above amount deposited on
my OIC.
Taxpayer ID Number
Type of Tax
Period
Amount to be Applied
(last 4 digits)
Sign here to acknowledge application of deposit
Date
14773
Catalog Number 68986V
Form
(Rev. 12-2017)
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Parent category: Financial