Form 656-P - Offer In Compromise
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2Form 656-P
Offer in Compromise
Item 1 — Taxpayer’s Name and Home or Business Address
_________________________________________________________________________________________
Name
Form 656-P (Rev. 1-2000)
_________________________________________________________________________________________
Catalog Number 16728N
Name
_________________________________________________________________________________________
Street Address
_________________________________________________________________________________________
City
State
ZIP Code
Mailing Address (if different from above)
_________________________________________________________________________________________
Street Address
_________________________________________________________________________________________
City
State
ZIP Code
Item 6 — I/we submit this offer for the reason(s) checked below:
Item 2 — Social Security Numbers
Doubt as to Liability — “I do not believe I owe this amount.”
(a) Primary ___________________________________________
You must include a detailed explanation of the reason(s) why
(b) Secondary _________________________________________
you believe you do not owe the tax in Item 9.
Doubt as to Collectibility — “I have insufficient assets and
Item 3 — Employer Identification Number (included in offer)
income to pay the full amount.” You must include a complete
____________________________________________________
financial statement, Form 433-OIC.
Effective Tax Administration — “I owe this amount and have
Item 4 — Other Employer Identification Numbers (not included
sufficient assets to pay the full amount, but due to my exceptional
in offer)
circumstances, requiring full payment would cause an economic
hardship or would be unfair and inequitable.” You must include
____________________________________________________
a complete financial statement, Form 433-OIC and complete
____________________________________________________
Item 9.
____________________________________________________
Item 7
Item 5 — To: Commissioner of Internal Revenue Service
I/we offer to pay $ _________________
I/We (includes all types of taxpayers) submit this offer to
Paid in full with this offer.
compromise the tax liabilities plus any interest, penalties, additions
Deposit of $ _________________ is attached to this offer.
to tax, and additional amounts required by law (tax liability) for the
tax type and period marked below: (Please mark an “X” in the box
No deposit.
for the correct description and fill-in the correct tax period(s),
Note: Make all checks payable to: The United States Treasury
adding additional periods if needed).
1040/1120 Income Tax — Year(s) _______________________
Check one of the following:
__________________________________________________
Cash Offer (Offered amount will be paid in 90 days or less.)
941 Employer’s Quarterly Federal Tax Return — Quarterly
Balance to be paid in: _______ 10, _______ 30, _______ 60, or
period(s) ___________________________________________
_________ 90 days from notice of acceptance of the offer. If
__________________________________________________
more than one payment will be made during the time frame checked,
provide the amount and date of the payment on the line below.
940 Employer’s Annual Federal Unemployment (FUTA) Tax
_____________________________________________________________________________
Return — Year(s) ____________________________________
Short Term Deferred Payment Offer (Offered amount paid in
__________________________________________________
more than 90 days but within 24 months.)
Amount of monthly payment ______________________________
Trust Fund Recovery Penalty as a responsible person of
(enter corporation name) ______________________________
Monthly payment date ___________________________________
_________________________________________________ ,
for failure to pay withholding and Federal Insurance
Date offered amount will be paid in full ______________________
Contributions Act Taxes (Social Security taxes), for period(s)
Other terms for payment _________________________________
ending ____________________________________________ .
Other Federal Tax(es) [specify type(s) and period(s)] ________
Deferred Payment Offer (Offered amount will be paid over
the life of the collection statute.)
___________________________________________________
Amount of monthly payment ______________________________
Note: If you need more space, use another sheet titled
“Attachment to Form 656-P Dated _______________ .”
Monthly payment date ___________________________________
Sign and date the attachment following the listing of
Other terms for payment _________________________________
the tax periods.
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