Form Icb-2 - Offer Of Disposition Of A Proposed Assessment Or Claim Denial - 2010
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Illinois Department of Revenue
ICB-2
Offer of Disposition of a Proposed
Assessment or Claim Denial
Read this information fi rst
You should complete and submit this form if you are making an offer
Note: Do not complete this form if you are making an offer in
compromise based on the inability to pay. If you are seeking relief
of disposition with the Informal Conference Board (ICB) to settle a
tax dispute with the department for a proposed assessment or claim
from your tax liability based only on your inability to pay, you should
denial. The ICB may accept an offer of disposition settling a tax
fi le a petition with the Board of Appeals after a fi nal assessment of
dispute only where the ICB fi nds that there is legitimate uncertainty
the tax has been issued.
regarding the facts or law in the case and if it would be in the best
interests of the State for the ICB to resolve the matter at this time.
Step 1: Identify yourself, your business, or your organization
4
___ ___ ___ - ___ ___ - ___ ___ ___ ___
1
_________________________________
SSN
Taxpayer’s name
Social Security number
5
___ ___ - ___ ___ ___ ___ ___ ___ ___
2
_________________________________
FEIN
Current address
Federal employer identifi cation number
Street address
6
Account ID _________________________________________
_________________________________
City
State
ZIP
7
License no. _________________________________________
(____)___________________________
Daytime phone no.
8
Write the audit ID or track number from the notice you received.
(____)____________________________
Fax no.
______________________________________________
9
If someone will represent you during the informal conference
3
_________________________________
Contact person
process, complete the following:
(For business or organization)
__________________________
Representative’s name ___
(____)____________________________
Daytime phone no.
Daytime phone no. (____)_________ Fax no.(____)__________
Step 2: Please provide the following information
1
Write the amount of your offer. (This amount must be a specifi c net dollar amount.)
$______________________
2
Write the penalty type(s)._________________________________________ Write the amount of penalty. $______________________
3
Identify all issues to be conceded, in whole or in part, by the taxpayer or by the Illinois Department of Revenue. Include the total dollar
amount associated with each issue and the dollar amount being offered to settle that specifi c issue. Attach additional sheets, if necessary.
____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________
Disclosure of this information is VOLUNTARY. This form has been approved by the Forms Management Center. IL-492-3508
ICB-2 (R-08/10)
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