Form 2000-4 - Settlement Or Compromise Of Tax Liability Form - Arkansas Department Of Finance And Administration

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Form 2000 - 4
Arkansas Department of Finance and Administration
Settlement or Compromise of Tax Liability
Submit this Form and other items listed in the checklist on page 6 to the following address.
An application without the required attachments will be returned for completion.
OIC Program
P.O. Box 1272, Rm. 2460, Ledbetter Building,
Little Rock, AR 72203-1272
Telephone – (501) 682-7751; Fax – (501) 683-0066
Item 1- Name of Individual Taxpayer or Primary Business Owner, Home Address & Telephone
Name:
:
Street Address
:
City, State, ZIP Code
: (
)
Telephone Number
Fax Number:
(
)
E-mail Address:
@
Item 2 – Business Name, Address and Telephone Number
Business Name:
Street Address:
City, State, ZIP Code:
Telephone Number: (
)
:
(
)
Fax Number
Item 3 - Social Security Numbers - Individual Taxpayer’s or Business Owner’s
(b) Secondary:
(
a) Primary:
Item 4 – Sales Tax Permit Number
-
-
Item 5 – Federal Employer Identification Numbers or other Permit Numbers
1
Rev 08/2008

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