Fillable Form 656 - Offer In Compromise (Page 2 of 7) in pdf

656

Department of the Treasury — Internal Revenue Service

Form

Offer in Compromise

(Rev. March 2017)

►

To: Commissioner of Internal Revenue Service

IRS Received Date

In the following agreement, the pronoun "we" may be assumed in place of "I" when there are joint liabilities and both parties

are signing this agreement.

I submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts

required by law for the tax type and period(s) marked in Section 2 or Section 3 below.

Did you use the Pre-Qualifier tool located on our website at

prior to filling out this form?

Yes

Note: The use of the Pre-Qualifier tool is not mandatory before sending in your offer. However, it is recommended.

Include the $186 application fee and initial payment (personal check, cashier's check, or money order) with your Form 656. You must also include the

completed Form 433-A (OIC) and/or 433-B (OIC) and supporting documentation. You should fill out either Section 1 or Section 2, but not both,

depending on the tax debt you are offering to compromise.

Section 1

Individual Information (Form 1040 filers)

If you are a 1040 filer, an individual with personal liability for Excise tax, individual responsible for Trust Fund Recovery Penalty, self-employed

individual, individual personally responsible for partnership liabilities, and/or an individual who operates as a single member LLC or a disregarded entity

taxed as a sole proprietorship you should fill out Section 1. You must also include all required documentation including the Form 433-A (OIC), the $186

application fee, and initial payment.

Your First Name, Middle Initial, Last Name

Social Security Number (SSN)

If a Joint Offer, Spouse's First Name, Middle Initial, Last Name

Social Security Number (SSN)

Your Physical Home Address

(Street, City, State, ZIP Code)

Your Home Mailing Address

(if different from above or Post Office Box number)

Is this a new address?

Yes

If yes, would you like us to update our records to this address?