Form R-20212a - Offer In Compromise Application - Louisiana Department Of Revenue - 2015 Page 3
Download a blank fillable Form R-20212a - Offer In Compromise Application - Louisiana Department Of Revenue - 2015 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 R-20212a - Offer In Compromise Application - Louisiana Department Of Revenue - 2015 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
2
3
4R-20212A (7/15)
10. Terms and Conditions
By submitting this offer and signing below, I/we understand and agree to LDR’s Offer in Compromise Terms and Conditions as follows:
(a) I/We will submit a non refundable application fee of $186 and a payment of at least 20 percent of the offer that I/We understand will be
applied as a partial payment toward my/our tax liability and will not be returned, regardless of the disposition of the offer.
(b) I/We will remain in compliance with all tax return filing provisions of the Revised Statutes during the existence of this offer.
(c) The offer remains pending until an authorized LDR representative issues written notification of acceptance or rejection, or until the offer
is withdrawn by me/us.
(d) I/We understand that collection enforcement activity will not be suspended while an offer is pending.
(e) LDR will retain and apply any payment toward the liability for which this offer is made, if the payment was received before official accep-
tance of the offer. LDR will retain any credits received before full payment of an accepted offer.
(f) I/We understand that the 20 percent down payment is nonrefundable and will be credited to the liability.
(g) I/We understand that the tax I/we owe is, and will remain, a tax liability until I/we meet all the terms and conditions of this
offer. If I/we file bankruptcy before the terms and conditions of this offer are completed, any claim LDR files in a bankruptcy
proceeding will be a tax claim.
(h) I/We understand that LDR will only consider one Offer in Compromise application in a 10-year period.
(i) I/We authorize LDR to obtain bank and financial information, as well as a credit history, from any consumer reporting agency for the
purpose of verifying the financial information provided by the Offer in Compromise applicant.
(j) If I/we fail to meet the terms and conditions of an accepted offer, the offer will be considered null and void. LDR will continue to add
applicable interest and penalty on the total unpaid balance until paid in full. In addition, LDR may:
(1) Immediately issue and record any tax lien necessary to protect the state’s legal interest;
(2) Proceed with enforced collection of the total outstanding liability;
(3) Apply amounts already paid under the offer to the total liability.
(k) It is also agreed that on notice to the taxpayer of the acceptance of this offer, the taxpayer shall have no right to contest, in court or other-
wise, the liability sought to be settled. If full payment is not received within 30 days after notification of the acceptance of this offer, the
Secretary of the Louisiana Department of Revenue or a designee may disregard the amount of the offer and, without notice of any kind,
assess and collect by seizure or any other legal means, the balance of the original liability.
(l) I/We waive prescription applicable to the assessment and collection of the liability sought to be settled and agree to the suspension of pre-
scription on assessment and collection for the period during which the offer is pending. The offer shall be deemed pending from the date of
acceptance of the waiver of prescription until the date the offer is formally accepted, rejected, or withdrawn in writing.
I/We have examined this offer, including accompanying schedules, returns, and statements, and hereby affirm that to the best of my/our knowledge
and belief it is true, correct, and complete.
________________________________________________________________________________ ________________________
Applicant’s Signature
Date
____________________________________________________________________________________________________
______________________________
Applicant’s Signature
Date
____________________________________________________________________________________________________
______________________________
Power of Attorney Signature
Date
____________________________________________________________________________________________________
______________________________
Notary Signature
Date
Note: LDR Forms R-20223 (Statement of Financial Condition for Individuals) or R-20222 (Statement of Financial Condition for
Businesses) must be completed, signed, and attached for this to be a complete offer. For individuals filing joint returns, both spouses must
sign. If the business is a corporation, this must be signed by an officer or board member; if a partnership or LLC, this must be signed by one
of the partners. LDR personnel may request verification of the financial information provided on these forms and may request additional
information.
6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ct-1120es - Estimate Corporation Business Tax - Connecticut Department Of Revenue - 2015
Financial
Form Oic-11 - Offer In Compromise Application Fee Waiver Request - Georgia Department Of Revenue
Financial
Related Categories
Parent category: Financial