Form 4180 - Report Of Interview With Individual Relative To Trust Fund Recovery Penalty Or Personal Liability For Excise Taxes Page 3

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Page 3
Section VI - Payroll Service Provider (PSP) or Professional Employer Organization (PEO)
A - Third-Party Payer Arrangements
(complete this section only if you are interviewing a taxpayer who used a third-party payer)
1. Who signed the service contract or entered into the agreement
2. Who in the business handled the contacts with the third-party
for services with the third-party payer?
payer?
3. Who was your contact at the third-party payer?
4. How were funds to be made available for the third-party payer to
pay the taxes?
Name of Bank(s) and Account number(s) from which funds
were to be transferred.
5. What actions did you take to verify the third-party payer was
6. Were funds available for the third-party payer to use for
filing returns, or making required payments?
payment of the taxes?
Yes
No
If yes, explain in detail how and when the money was
transferred to the third-party.
7. Were you aware that the third-party payer was not making the
8. Did you receive IRS notices indicating that the employment tax
required payments?
returns were not filed, or that the employment taxes were not
paid?
Yes
No
Yes
No
B - Third-Party Payer Companies
(complete this section only if you are interviewing a Third-Party Payroll Service Payer)
1. Who in your organization handled the contacts with the client?
2. Who was your contact at the client business?
3. Who at the client business signed the service contract or
4. Who had control over the payments of the client's employment
entered into the agreement for services?
taxes?
5. How were funds to be made available from the client business to pay the taxes?
Account Number(s)
Bank Name(s)
6. Were there funds actually available for you to make the tax payments?
Yes
No
If yes, explain in detail how and when the money was transferred to the third-party.
If no, what actions did you take to attempt to collect the funds from the client?
Section VII - Personal Liability for Excise Tax Cases
(Complete only if Business is required to file Excise Tax Returns)
1. Are you aware of any required excise tax returns which have not
2. With respect to excise taxes, were the patrons or customers
been filed?
informed that the tax was included in the sales price?
No
Yes
No
Yes
(list periods)
3. If the liability is one of the ''collected'' taxes (transportation of
4. Were you aware, during the period tax accrued, that the law
required collection of the tax?
persons or property and communications), was the tax
collected?
No
Yes
No
Yes
4180
Form
(Rev. 8-2012)
Catalog Number 22710P

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