Form 4180 - Report Of Interview With Individual Relative To Trust Fund Recovery Penalty Or Personal Liability For Excise Taxes Page 2

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Section IV - Business Information
1. List corporate positions below, identifying the persons who occupied them and their dates of service.
Position
Name
Address
Dates
(e.g. president, director)
2. Did/does the business use the Electronic Federal Tax Payment
3. Other than the EFTPS, does the business do any other banking
System (EFTPS) to make Federal Tax Deposits (FTD's) or
electronically?
payments?
No
Where
No
Yes
Yes
If yes, to whom are the PINS or passwords assigned
To whom are the PINs/passwords assigned
4. Does the business file Form 941 electronically?
No
Who is authorized to sign Form 941
Yes
Who files the returns electronically
Section V - Knowledge / Willfulness
1. During the time the delinquent taxes were increasing, or at any time thereafter, were any financial obligations of the business paid?
(such as rent, mortgage, utilities, vehicle or equipment loans, or payments to vendors)
No
Yes
Which obligations were paid?
Who authorized them to be paid?
2. Were all or a portion of the payrolls met?
3. Did any person or organization provide funds to pay net corporate payroll?
No
No
Yes
Yes
(explain in detail and provide name)
Who authorized
5. What actions did you attempt to see that the taxes were paid?
4. When and how did you first become aware of the unpaid taxes?
6. Were discussions ever held by stockholders, officers, or other
7. Who handled IRS contacts such as phone calls,
interested parties regarding nonpayment of the taxes?
correspondence, or visits by IRS personnel?
No
Yes
Identify who attended, dates, any decisions reached, and
When did these contacts take place, and what were the results
whether any documentation is available.
of these contacts?
4180
Form
(Rev. 8-2012)
Catalog Number 22710P

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