Request For Adjustment Form 3870
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41. TIN
Cross Reference TIN
Department of the Treasury
Internal Revenue Service
taxpayer SSN or EIN
2. Name
3. Originating Office
request
TP name
for
Street Address
address
adjustment
TC
CC
State
Zip Code
Telephone Number
City
(
)
Catalog No. 22515Q
4. MFT
5. Period Ending
7. Source
6. Assessment Date
X
TDA
Letter
Claim
Other
of the amended
return
date of the payment
8. DLN
9. Renumbered DLN
10. Personal Contact
DLN of the payment to be moved
Yes
No
POA
Reason for Adjustment
11.
RE: Return Excess Collection monies back to tax module for MFT 30, TY 200x
Taxpayer(s) filed a taxable amended return for unreported income from previously undisclosed offshore assets.
Payment of $x,xxx was submitted with amended return and it posted as TC (e.g. 670, 640) with DLN
Payment subsequently transferred to Excess Collection via TC 672, dated xx/xx/xxxx).
Please prepare F.8765 to move the credit back to tax module MFT & YR.
Statute of Limitations open for TY 200x via IRC 6501(e)(1)(A)(ii) for unreported foreign inc in excess of $5,000
12.
I hereby request that the items indicated above be included or changed on my Federal Tax Return or account as identified.
Date
Signature of Taxpayer
13. Signature of Preparer
Telephone (work)
(FAX)
Date
your phone #
14. Approving Official Signature and Title
Date
secure GM's signature
Assessment, Item, or Credit Adjustment Processing Information
15. Sequence Number
16. Blocking Series
17. Del. Int. to Date
18. Source Code
19. Reason Code
20. Math Error Code
21. Hold Code
22. Other
23. Priority Code
24. Posting Delay Code
25. Source Doc. Attached
26. Other
27.
28.
29.
TC No.
Increase / Decrease
Item Adjustment
Ref. No.
Ref. No.
Credit Adj.
30. Remarks
31. Terminal Operator's Number
Employee I.D.
Date Input
3870
Form
(Rev. 8-1994)
publish.no.irs.gov
Part 1
Copy for Adjustments Branch
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