Fillable Form 656 - Offer In Compromise (Including Form 433-A (Oic), Form 433-B (Oic)) (Page 24 of 28) in pdf

Page 4 of 4

Section 8 -

Offer Terms

(Continued)

defines pending and withdrawal). I understand that I have the right not to waive the statutory period of

assessment or to limit the waiver to a certain length or certain periods or issues. I understand, however, that the

IRS may not consider my offer if I refuse to waive the statutory period of assessment or if I provide only a limited

waiver. I also understand that the statutory period for collecting my tax debt will be suspended during the time my

offer is pending with the IRS, for 30 days after any rejection of my offer by the IRS, and during the time that any

rejection of my offer is being considered by the Appeals Office.

I understand the IRS may file

l) The IRS may file a Notice of Federal Tax Lien during the offer investigation. The IRS may file a Notice of

a Notice of Federal Tax Lien

Federal Tax Lien to protect the Government's interest on offers that will be paid over time. This tax lien will be

on my property.

released when the payment terms of the accepted offer have been satisfied.

I authorize the IRS to contact

m) By authorizing the IRS to contact third parties including credit bureaus, I understand that I will not be notified of

relevant third parties in order

which third parties the IRS contacts as part of the offer application process, as stated in section 7602(c) of the

to process my offer

Internal Revenue Code.

I am submitting an offer as

n) I understand if the liability sought to be compromised is the joint and individual liability of myself and my

an individual for a joint

co-obligor(s) and I am submitting this offer to compromise my individual liability only, then if this offer is accepted,

liability

it does not release or discharge my co-obligor(s) from liability. The United States still reserves all rights of

collection against the co-obligor(s).

Section 9

Signatures

Under penalties of perjury, I declare that I have examined this offer, including accompanying schedules and statements, and to the best of

my knowledge and belief, it is true, correct and complete.

Phone Number

Date (mm/dd/yyyy)

Signature of Taxpayer/Corporation Name

Phone Number

Date (mm/dd/yyyy)

Signature of Taxpayer/Authorized Corporate Officer

Paid Preparer Use Only

Section 10

Phone Number

Date

(mm/dd/yyyy)

Signature of Preparer

Name of Paid Preparer

Preparer's CAF no. or PTIN

Firm's Name, Address, and ZIP Code

Include a valid, signed Form 2848 or 8821 with this application, if one is not on file.

Third Party Designee

Section 11

Do you want to allow another person to discuss this offer with the IRS?

Yes

If yes, provide designee's name

Telephone Number

(

)

IRS Use Only

I accept the waiver of the statutory period of limitations on assessment for the Internal Revenue Service, as described in Section 8 (k).

Signature of Authorized Internal Revenue Service Official

Title

Date (mm/dd/yyyy)

Privacy Act Statement

We ask for the information on this form to carry out the internal revenue laws of the United States. Our authority to request this information is Section 7801 of the Internal

Revenue Code.

Our purpose for requesting the information is to determine if it is in the best interests of the IRS to accept an offer. You are not required to make an offer; however, if you

choose to do so, you must provide all of the taxpayer information requested. Failure to provide all of the information may prevent us from processing your request.

If you are a paid preparer and you prepared the Form 656 for the taxpayer submitting an offer, we request that you complete and sign Section 10 on Form 656, and provide

identifying information. Providing this information is voluntary. This information will be used to administer and enforce the internal revenue laws of the United States and may

be used to regulate practice before the Internal Revenue Service for those persons subject to Treasury Department Circular No. 230, Regulations Governing the Practice of

Attorneys, Certified Public Accountants, Enrolled Agents, Enrolled Actuaries, and Appraisers before the Internal Revenue Service. Information on this form may be disclosed

to the Department of Justice for civil and criminal litigation.

We may also disclose this information to cities, states and the District of Columbia for use in administering their tax laws and to combat terrorism. Providing false or

fraudulent information on this form may subject you to criminal prosecution and penalties.

656

Catalog Number 16728N

Form

(Rev. 5-2012)