Irs Form 872 B
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1
2In reply refer to:
Department of the Treasury - Internal Revenue Service
872-B
Consent to Extend the Time to Assess
Form
Taxpayer Identification Number
(Rev. July 2003)
Miscellaneous Excise Taxes
, taxpayer(s)
(Name(s))
of
and the
(Number, Street, City or Town, State, ZIP Code)
Commissioner of Internal Revenue consent and agree to the following:
(1) The amount of liability for
tax, imposed on the taxpayer(s) by
(Kind)
section
of the
due for the period
(Internal Revenue Code, Revenue Act, etc.)
may be assessed at any time on or before
(Expiration date)
(2) The collection provisions and limitations now in effect will also apply to any tax assessed within the extended period.
(3) The taxpayer(s) may file a claim for credit or refund and the Service may credit or refund the tax within 6 months after
this agreement ends.
MAKING THIS CONSENT WILL NOT DEPRIVE THE TAXPAYER(S) OF ANY APPEAL
RIGHTS TO WHICH THEY WOULD OTHERWISE BE ENTITLED.
YOUR SIGNATURE HERE
(Date signed)
TAXPAYER'S REPRESENTATIVE
SIGN HERE
(Date signed)
CORPORATE
NAME
(Title)
(Date signed)
CORPORATE
OFFICER(S)
SIGN HERE
(Date signed)
(Title)
INTERNAL REVENUE SERVICE SIGNATURE AND TITLE
(Division Executive Name - see instructions)
(Division Executive Title - see instructions)
BY
(Authorized Official Signature and Title - see instructions)
(Date signed)
(Signature instructions are on the back of this form)
872-B
Catalog No. 61485N
Form
(Rev. 7-2003)
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