The IRS Collection ProcessPublication 594

This publication provides a general description of the IRS collection process. The collection process is a series of actions that the IRS can take to collect the taxes you owe if you don’t voluntarily pay them. The collection process will begin if you don’t make your required payments in full and on time, after receiving your bill.

Please keep in mind that this publication is for information only, and may not account for every tax collection scenario. It’s also not a technical analysis of tax law and does not include a detailed explanation of your rights. For an explanation of your rights, please see Publication 1, Your Rights as a Taxpayer.

If you have questions or need help

Please visit http://www.irs.gov/Forms-&-Pubs to find all the IRS tax forms and publications mentioned here, or to do a keyword search on any topic. You can visit www.irsvideos.gov to view informational videos on a variety of topics in this publication.

You can also visit your local IRS office, or call the number on your bill. If you don’t have a bill, please call: 1-800-829-1040 (individuals) or 1-800-829-4933 (businesses). Before visiting your local IRS office, check the “Services Provided” and the hours of operation at www.irs.gov/localcontacts. Use the “Office Locator” link by entering your zip code to locate the nearest office which will give you the office address, hours of operation, and services provided.

Overview: Filing a tax return, billing, and collection 2General steps from billing to collection 2What you should do when you get an IRS bill 2Who to contact for help 2

Ways to pay your taxes 2

Options for paying in full 2Options if you can’t pay in full now 2If you need more time to pay 3How long we have to collect taxes 3How to appeal an IRS decision 3

If you don’t pay on time: Understanding collection actions 4

Collection actions in detail 5Federal tax lien 5Notice of Federal Tax Lien 5Levy: A seizure of property 6Summons: Used to secure information 7

Information for employers: Collection of employment tax 7

Additional information 8

Publication 594 (Rev. 1-2015) Catalog Number 46596B Department of the Treasury Internal Revenue Service www.irs.gov

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Overview: Filing a tax return, billing, and collectionAfter you file your tax return and/or a final decision is made establishing your correct tax, we record the amount in our records. If you owe, we will send a bill for the amount due, including any penalties and interest. If you owe, and you don’t pay or make arrangements to settle the amounts you owe, we can take collection actions to collect the debt. Our goal is to work with you to resolve your debt before we take collection actions. If your bill is for an individual shared responsibility payment as a result of the Affordable Care Act, the amount owed is not subject to penalties, levies or the filing of a Notice of Federal Tax Lien. However, interest will continue to accrue and the Service may offset federal tax refunds until the balance is paid in full.

General steps from billing to collectionYou file your tax return. Most returns are filed annually (by April 15th) or quarterly (businesses with employees).

1. If you owe taxes, we will send you a bill. This is your first bill for tax due. Based on your return, we will calculate how much tax you owe, plus any interest and penalties.

2. If you don’t pay your first bill, we will send you at least one more bill. Remember, interest and penalties continue to accrue until you’ve paid your full amount due.

3. If you still don’t pay after you receive your final bill, we will begin collection actions. Collection actions can range from applying your subsequent tax year refunds to tax due (until paid in full) to seizing your property and assets.

What you should do when you get an IRS billIf you agree with the information on the bill, pay the full amount before the due date. If you can’t pay the full amount due, pay as much as you can, and immediately contact us to explain your situation. You should have your financial information available, including your monthly income and expenses. Based on your ability to pay, we may provide you with alternate payment options.

If you disagree with the information on the bill, call the number on the bill, or visit your local IRS office. Be sure to have a copy of the bill and any tax returns, cancelled checks, or other records that will help us understand why you believe your bill is wrong. If we find that you’re right, we will adjust your account and, if necessary, send a revised bill.

If you don’t pay the amount due or tell us why you disagree with it, we may take collection actions.

If you are in bankruptcy, please notify us immediately. The bankruptcy may not eliminate your tax debt, but we may temporarily stop collection. Call the number on your bill or 1-800-973-0424. Have the following information available: the location of court, bankruptcy date, chapter and bankruptcy number.

Who to contact for helpThe Internal Revenue ServicePlease don’t hesitate to contact us with any questions you may have. Call the number on your bill or 1-800-829-1040. You can also visit your local IRS office to speak with an IRS representative in person. You can also find answers to your questions at www.irs.gov

Taxpayer Advocate ServiceThe Taxpayer Advocate Service is an independent organization

within the Internal Revenue Service that helps taxpayers. They help taxpayers whose problems with the IRS are causing financial difficulties, who have tried but haven’t been able to resolve their problems with the IRS, and those who believe an IRS system or procedure is not working as it should. Their service is free. Your local advocate’s number is at www.taxpayeradvocate.irs.gov, www.irs .gov/advocate, and in your local directory. You can also call us at 1-877-777-4778. For more information about TAS and your rights under the Taxpayer Bill of Rights, go to www.taxpayeradvocate .irs.gov. The Taxpayer Advocate Service is your voice at the IRS.

Low Income Taxpayer ClinicsLow Income Taxpayer Clinics are independent from the IRS. Some clinics serve individuals whose income is below a certain level and who need to resolve a tax problem. These clinics provide professional representation before the IRS or in court on audits, appeals, tax collection disputes, and other issues for free or for a small fee. Some clinics can provide information about taxpayer rights and responsibilities in many different languages for individuals who speak English as a second language. For more information and to find a clinic near you, see the Low Income Taxpayer Clinics page on www.taxpayeradvocate.irs.gov or Publication 4134, Low Income Taxpayer Clinic List. This publication is also available by calling 1-800-829-3676.

Ways to pay your taxesTo minimize interest and penalties, we recommend paying your taxes in full. However, if you’re unable to pay in full, you can request an Installment Agreement or Offer in Compromise. These payment plans allow you to pay your taxes in installments over time, to pay less than you owe, or both. It’s also important to stay current on your payments for future taxes. This means making your estimated tax payments, withholding payments, or federal tax deposits as required by law.

Options for paying in fullElectronic paymentsDirect Pay is a convenient, secure way to pay your individual tax bill or estimated tax payment directly from your checking or savings account at no cost to you. For more information, visit www.irs.gov /Payments/Direct-Pay.

Another electronic payment option is the Electronic Federal Tax Payment System (EFTPS). To enroll, visit www.eftps .com or call 1-800-555-4477. For more information, see Publication 966, Electronic Choices to Pay All Your Federal Taxes.

Pay with your credit or debit cardFor a fee, you can pay by credit or debit card by using an electronic payment service provider. For more information on making a payment using a credit or debit card, visit www.irs.gov/e-pay.

Pay by mail or in person at a local IRS office You can mail a check to us at the address listed on your bill or bring it to your local IRS office. Make checks payable to the Department of the Treasury.

Options if you can’t pay in full nowApply for an Installment AgreementAn Installment Agreement with the IRS means that we will allow you to make smaller periodic payments over time if you can’t pay the full amount at once. There are several ways to apply for an Installment Agreement:

• Online, using the Online Payment Agreement application at http://www.irs.gov/Individuals/Online-Payment -Agreement-Application. Apply online if you owe $50,000 or less in the combined balance total of individual income tax, penalties and interest. If you own a business and owe $25,000

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or less in combined payroll taxes, penalty and interest for the current and prior calendar year, you can also use the Online Payment Agreement to request a payment agreement. To view an instructional video on the Online Payment Agreement application, visit http://www.irsvideos.gov/Individual /PayingTaxes/OPA.

• By phone Please call the number on your bill or 1-800-829-1040.

• By mail Please complete Form 9465, Installment Agreement Request. In addition to Form 9465, if you want to make your payments by payroll deduction, complete Form 2159, Payroll Deduction Agreement. If you owe more than $50,000, you will also need to complete Form 433F, Collection Information Statement. Mail your form to the address on your bill.

• In person at your local IRS office near you, please visit www.irs .gov/localcontacts.

If you request a payment plan, you can reduce the accrual of penalties and interest by making voluntary payments according to the proposed plan’s terms until you’re notified whether we’ve accepted your payment plan request. Our acceptance of your interim payments doesn’t mean we’ve approved your request. We will notify you in writing once we’ve made our decision.

With an Installment Agreement, you can pay by direct debit, through payroll deductions, electronic funds transfer or check. There’s a user fee for Installment Agreements. If you meet our low-income guidelines, you can pay a reduced user fee. For more information, see Form 13844, Application for Reduced User Fee for Installment Agreements. You do not need to submit the user fee for an installment agreement with the application. The fee can be taken from the initial payments made once the installment agreement is accepted.

To be eligible for an Installment Agreement, you must file all required tax returns. Prior to approving your Installment Agreement request, we may ask you to complete a Collection Information Statement (Form 433F, 433-A and/or Form 433-B) and provide proof of your financial status. Please have your financial information available if you apply over the phone or at an IRS office. For more information, see Publication 1854, How to Complete a Collection Information Statement (Form 433-A).

If we approve your request, we will still charge applicable interest and penalties until you pay the amount or balance due in full, and may file a Notice of Federal Tax Lien (see page 4). If we reject your Installment Agreement request, you may request that the Office of Appeals review your case. For more information, see Publication 1660, Collection Appeal Rights.

If you’re unable to meet the terms of your approved Installment Agreement, please contact us immediately.

Apply for an Offer in CompromiseYou may be eligible for an Offer in Compromise if you can’t pay the amount you owe in full or through installments. By requesting an Offer in Compromise, you’re asking to settle unpaid taxes for less than the full amount you owe. We may accept an Offer in Compromise if:

• We agree that your tax debt may not be accurate,• You have insufficient assets and income to pay the amount due,

or• Because of your exceptional circumstances, paying the amount

due would cause an economic hardship or would be unjust.

For an Offer in Compromise to be considered, you must pay an application fee and make an initial or periodic payment. However, low income taxpayers may qualify for a waiver of the application fee and initial or periodic payment. For more information, please see the Low Income Certification on Form 656, Offer in Compromise. This

form is contained in Form 656-B, Offer in Compromise Booklet.

You can use the Offer in Compromise Pre-Qualifier tool at http://irs .treasury.gov/oic_pre_qualifier/ to explore the possibility that the Offer in Compromise program may be a realistic option to resolve your balance due. To apply for an Offer in Compromise, complete one of the following forms:

• Form 656-L, Offer in Compromise (Doubt as to Liability) Complete this if you think your tax debt isn’t accurate.

• Form 656, Offer in Compromise Complete this if you’re unable to pay the amount due, or have an economic hardship, or have another special circumstance that would cause paying the amount due to be unjust.

For more information, see Form 656-B, Offer in Compromise Booklet or visit www.irs.gov/Individuals/Offer-in-Compromise-1.

If you need more time to payAsk that we delay collection and report your account as currently not collectableIf you can’t pay any of the amount due because payment would prevent you from meeting basic living expenses, you can request that we delay collection until you’re able to pay. Prior to approving your request, we may ask you to complete a Collection Information Statement and provide proof of your financial status. Please remember that even if we delay collection, we will still charge applicable penalties and interest until you pay the full amount, and we may file a Notice of Federal Tax Lien (see page 4). We may also request updated financial information during this temporary delay to review your ability to pay.

How long we have to collect taxesWe can attempt to collect your taxes up to 10 years from the date they were assessed. However, there are ways this time period can be suspended. For example, by law, the time to collect may be suspended while:

• We’re considering your request for an Installment Agreement or Offer in Compromise. If your request is rejected, we will suspend collection for another 30 days, and during any period the Appeals Office is considering your appeal request.

• You live outside the U.S. continuously for at least 6 months. Collection is suspended while you’re outside the U.S.

• The tax periods we’re collecting on are included in a bankruptcy with an automatic stay. We will suspend collection for the time period we can’t collect because of the automatic stay, plus 6 months.

• You request a Collection Due Process hearing. Collection will be suspended from the date of your request until a Notice of Determination is issued or the Tax Court’s decision is final.

• We’re considering your request for Innocent Spouse Relief. Collection will be suspended from the date of your request until 90 days after a Notice of Determination is issued, or if you file a timely petition to the Tax Court, until 60 days after the Tax Court’s final decision. If you appeal the Tax Court’s decision to a U.S. Court of Appeals, the collection period will begin 60 days after the appeal is filed, unless a bond is posted.

How to appeal an IRS decisionYou have the right to appeal most collection actions to the IRS Office of Appeals (Appeals). Appeals is separate from and independent of the IRS Collection office that initiates collection actions. Appeals ensures and protects its independence by adhering to a strict policy prohibiting certain communications with the IRS Collection office or other IRS offices, such as discussions regarding the strength or weakness of your case. When an IRS office is to be engaged in discussions, you will be invited you to

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participate in the conference, or provided any written document to give you an opportunity to comment. Your main options for appeals are the following: Collection Due Process or Collection Appeals Program

Collection Due ProcessThe purpose of a Collection Due Process hearing is to have Appeals review collection actions that were taken or have been proposed. After Appeals has made their determination and you do not agree, you can go to court to appeal the Appeals’ Collection Due Process determination. You can request a Collection Due Process hearing if you receive any of the following notices:

• Notice of Federal Tax Lien Filing and Your Right to a Hearing• Final Notice—Notice of Intent to Levy and Notice of Your Right

to a Hearing• Notice of Jeopardy Levy and Right of Appeal• Notice of Levy on Your State Tax Refund—Notice of Your Right

to a Hearing• Notice of Levy and of Your Right to a Hearing

To request a Collection Due Process hearing, complete Form 12153, Request for a Collection Due Process or Equivalent Hearing or a written request containing the same information as contained in Form 12153, and send it to the address on your notice. You must request a Collection Due Process hearing by the date indicated in the notice we send you (for proposed levies, that date is 30 days from the date of the letter). The request must be filed timely to preserve your right to judicial review of the determination issued in your Collection Due Process hearing. If your request for a Collection Due Process hearing is not timely, you can request an Equivalent Hearing within one year from the date of the notice, but you cannot go to court if you disagree with Appeals’ decision.

During a Collection Due Process hearing, the 10-year period for collecting taxes is suspended and we are generally prohibited from seizing (levying) your property, if seizing your property is the subject of the hearing. We are permitted to seize your property during an Equivalent Hearing or a Collection Due Process hearing about filing of a Notice of Federal Tax Lien, but normally we will not seize property during these hearings. The 10-year period for collecting taxes is not suspended during an Equivalent Hearing.

You are entitled to only one Collection Due Process lien hearing and one levy hearing for each tax period or assessment. You are entitled to propose collection alternatives, such as entering into an installment agreement or an offer-in-compromise, for consideration by Appeals in the hearing. It may be necessary for you to submit financial information or tax returns to qualify for such collection alternatives.

All issues should be raised and all necessary supporting information presented to Appeals at the hearing. Your are prevented from raising issues during a judicial review that were not properly raised with Appeals in the Collection Due Process hearing. Your Appeals conference may be held by telephone, correspondence, or, if you qualify, in a face-to-face conference at the Appeals office closest to your home or place of business. You may be denied a face-to-face conference if you raise issues that are deemed frivolous or made with a desire solely to delay or impede collection. For a nonexclusive listing of issues identified by the IRS as frivolous, see “The Truth About Frivolous Tax Arguments” on www.IRS.gov.

Collection Appeals ProgramUnder the Collections Appeals Program, if you disagree with an IRS employee’s decision regarding any levy, seizure, or Notice of Federal Tax Lien filing and want to appeal it, you can ask to have a conference with the employee’s manager. If we seize your house, car, or other property in order to sell your interest in the property to apply the proceeds to your tax debt, you must make the request within 10 business days after the Notice of Seizure is given to you

or left at your home or business. There is no deadline to request a manager conference when a levy is served for other types of property (such as wages or bank accounts) or a levy or seizure or lien filing is proposed. The collection action may go forward if a conference is not requested within a reasonable time period.

If you then disagree with the manager’s decision, you may request the IRS Office of Appeals review your case under the Collection Appeals Program as outlined in Publication 1660. If your case is assigned to a revenue officer, your request for Appeals consideration should be made within three (3) business days of the conference with the manager or collection actions may resume. You must submit your request for Appeals consideration in writing, preferably on Form 9423, Collection Appeal Request. If your case is not assigned to a Revenue Officer, you can appeal the manager’s decision in writing or orally and your case will be forwarded to Appeals for review. Your request for Appeals consideration should be made within three (3) business days of the conference with the manager or collection actions may resume.

If you request a conference and are not contacted by a manager or his/her designee within two (2) business days of making the request, you may contact Collection again and request Appeals consideration. If you submit Form 9423, note the date of your request for a conference in Block 15 and indicate that you were not contacted by a manager. The Form 9423 should be received or postmarked within four (4) business days of your request for a conference as collection action may resume. Submit Form 9423 to the revenue officer involved in the lien, levy or seizure action.

If you file a Collection Appeals Request and do not agree with Appeals decisions, you cannot proceed to court.

Instances in which you can pursue the Collection Appeals Program include, but aren’t limited to:

• Before or after we file a Notice of Federal Tax Lien • Before or after we seize (“levy”) your property • After we reject, terminate, or propose to terminate your

Installment Agreement (a conference with the manager is recommended, but not required). Submit your written Installment Agreement Appeal request, preferably using Form 9423, Collection Appeal Request, within the timeframe listed in your notice.

For more information about the Collection Due Process and Collection Appeals Program, please see Publication 1660, Collection Appeal Rights or visit http://www.irs.gov/Individuals /Appealing-a-Collection-Decision.

If you don’t pay on time: Understanding collection actionsThere are several words and phrases particular to the collection process. Here, we’ve defined some of the most commonly used collection terms:

Federal tax lien: A legal claim against all your current and future property, such as a house or car, and rights to property, such as wages and bank accounts. The lien automatically comes into existence if you don’t pay your amount due after receiving your first bill.

Notice of Federal Tax Lien: A public notice to creditors. It notifies them that there is a federal tax lien that attaches to all your current and future property and rights to property.

Levy: A legal seizure of property or rights to property to satisfy a tax debt. When property is seized (“levied”), it will be sold to help pay your tax debt. If wages or bank accounts are seized, the money will be applied to your tax debt.

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Seizure: There is no legal difference between a seizure and a levy. Throughout this publication, we will use both terms interchangeably.

Notice of Intent to Levy and Notice of Your Right to a Hearing: Generally, before property is seized, we have to send you this notice. If you don’t pay your overdue taxes, make other arrangements to satisfy the tax debt, or request a hearing within 30 days of the date of this notice, we may seize your property.

Summons: A summons legally compels you or a third party to meet with the IRS and provide information, documents or testimony.

Collection actions in detailFederal tax lien: A legal claim against propertyA lien is a legal claim against all your current and future property. When you don’t pay your first bill for taxes due, a lien is created by law and attaches to your property. It applies to property (such as your home and car) and to any current and future rights you have to property.

Notice of Federal Tax Lien: Provides public notice to creditors that a lien existsA Notice of Federal Tax Lien gives public notice to creditors. We file the Notice of Federal Tax Lien so we can establish the priority of our claim versus the claims of other creditors. The Notice of Federal Tax Lien is filed with local or state authorities, such as county recorder of deeds or the Secretary of State offices.

If a Notice of Federal Tax Lien is filed against you, it’s often reported by consumer credit reporting agencies. This can have a negative effect on your credit rating and make it difficult for you to receive credit (such as a loan or credit card). Employers, landlords and others may also use this information and not favorably view the fact that a Notice of Federal Tax Lien has been filed against you. However by law, there will be no filing of the Notice of Federal Tax Lien or enforcement action taken to collect an individual shared responsibility payment associated with the Affordable Care Act.

What to do if a Notice of Federal Tax Lien is filed against youYou should pay the full amount you owe immediately. The Notice of Federal Tax Lien only shows your assessed balance as of the date of the notice. It doesn’t show your payoff balance or include our charges for filing and releasing the lien. To find out the full amount you must pay to have the lien released, call 1-800-913-6050 or 859-669-4811 if you are calling from outside of the United States. If you have questions, call the number on your lien notice or 1-800-829-1040 or visit www.irs.gov/Businesses/Small -Businesses-&-Self-Employed/Understanding-a-Federal-Tax-Lien, or view instructional videos at http://www.irsvideos.gov/Individual/IRSLiens.

How to appeal a Notice of Federal Tax LienWithin five business days of the first filing of the Notice of Federal Tax Lien for a specific debt, we will send you a Notice of Federal Tax Lien Filing and Your Right to a Collection Due Process Hearing. You’ll have until the date shown on the notice to request a Collection Due Process hearing with the Office of Appeals. Send your Collection Due Process hearing request to the address on the notice. For more information, see Form 12153, Request for a Collection Due Process or Equivalent Hearing.

After your Collection Due Process hearing, the Office of Appeals will issue a determination on whether the Notice of Federal Tax Lien should remain filed, or whether it should be withdrawn, released, discharged or subordinated. If you disagree with the determination, you have 30 days after it’s made to seek a review in the U.S. Tax Court.

In addition to any Collection Due Process rights you may have, you may also appeal a proposed or actual filing of a Notice of Federal

Tax Lien under the Collection Appeals Program.

Reasons we will “release” a federal tax lienA “release” of a federal tax lien means that we have cleared both the lien for your debt and the public Notice of Federal Tax Lien. We do this by filing a Certificate of Release of Federal Tax Lien with the same state and local authorities with whom we filed your Notice of Federal Tax Lien. We will release your lien if:

• Your debt is fully paid,• Payment of your debt is guaranteed by a bond, or• You have met the payment terms of an Offer in Compromise

which the IRS has accepted, or• The period for collection has ended. (In this case, the release is

automatic.)

For more information, see Publication 1450, Instructions on How to Request a Certificate of Release of Federal Tax Lien.

Reasons we may “withdraw” a Notice of Federal Tax LienA “withdrawal” removes the Notice of Federal Tax Lien from public record. The withdrawal tells other creditors that we’re abandoning our lien priority. This doesn’t mean that the federal tax lien is released or that you’re no longer liable for the amount due.

We may withdraw a Notice of Federal Tax Lien if:

• You’ve entered into an Installment Agreement to satisfy the tax liability, unless the Agreement provides otherwise. For certain types of taxes, we will routinely withdraw a Notice of Federal Tax Lien if you’ve entered into a direct debit installment agreement and meet certain other conditions,

• It will help you pay your taxes more quickly,• We didn’t follow IRS procedures,• It was filed during a bankruptcy automatic stay period, or• It’s in your best interest and in the best interest of the

government. For example, this could include when your debt has been satisfied and you request a withdrawal.

For more information, see Form 12277, Application for Withdrawal of Filed Notice of Federal Tax Lien or the instructional video at http://www.irsvideos.gov/Individual/IRSLiens /LienNoticeWithdrawal.

How to apply for a “discharge” of a federal tax lien from propertyA “discharge” removes the lien from specific property. There are several circumstances under which the federal tax lien can be discharged. For example, we may issue a Certificate of Discharge if you’re selling property and a Notice of Federal Tax Lien has been filed; you may be able to remove or discharge the lien from that property if the government receives its interest through the sale. For more information on whether you qualify for a discharge, see Publication 783, Instructions on How to Apply for a Certificate of Discharge of Property from Federal Tax Lien. To watch an instructional video about Publication 783, visit http://irsvideos.gov/Individual/IRSLiens.

How to make the federal tax lien secondary to other creditors (“subordination”)A “subordination” is where a creditor is allowed to move ahead of the government’s priority position. For example, if you’re trying to refinance a mortgage on your home, but aren’t able to because the federal tax lien has priority over the new mortgage, you may request that we subordinate our lien to the new mortgage. For more information on whether you qualify for a subordination, see Publication 784, How to Prepare an Application for a Certificate of Subordination of Federal Tax Lien. To watch an instructional video about Publication 784, visit http://irsvideos.gov/Individual /IRSLiens.

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Appeal rights for withdrawal, discharge or subordinationIf your application is denied you will receive Form 9423, Collection Appeal Request and Publication 1660, Collection Appeal Rights, with an explanation of why your application was denied. If we deny your request for a withdrawal, discharge, or subordination, you may appeal under the Collections Appeals Program.

Levy: A seizure of propertyWhile a federal tax lien is a legal claim against your property, a levy is a legal seizure that actually takes your property (such as your house or car) or your rights to property (such as your income, bank account, or Social Security payments) to satisfy your tax debt.

We can’t seize your property if you have a current or pending Installment Agreement, Offer in Compromise, or if we agree that you’re unable to pay due to economic hardship, meaning seizing your property would result in your inability to meet basic, reasonable living expenses.

Reasons we may seize (“levy”) your property or rights to propertyIf you don’t pay your taxes (or make arrangements to settle your debt), we could seize and sell your property. We will not seize your property to collect an individual shared responsibility payment. We usually seize only after the following things have occurred.

• We assessed the tax and sent you a bill,• You neglected or refused to pay the tax, and• We sent you a Final Notice of Intent to Levy and Notice of Your

Right to a Hearing at least 30 days before the seizure.

However, there are exceptions for when we don’t have to offer you a hearing at least 30 days before seizing your property. These include situations when:

• The collection of the tax is in jeopardy, • A levy is served to collect tax from a state tax refund,• A levy is served to collect the tax debt of a federal contractor, or• A Disqualified Employment Tax Levy (DETL) is served. A DETL

is the seizure of unpaid employment taxes and can be served when a taxpayer previously requested a Collection Due Process appeal on employment taxes for other periods within the past 2 years.

If we serve a levy under one of these exceptions, we will send you a letter explaining the seizure and your appeal rights after the levy is issued.

What you should do if your property is seized (“levied”) If your property or federal payments are seized, call the number on your levy notice or 1-800-829-1040. If you’re already working with an IRS employee, call him or her for assistance.

Examples of property we can seize (“levy”)• Wages, salary, or commission held by someone else If

we seize your rights to wages, salary, commissions, or similar payments that are held by someone else, we will serve a levy once, not each time you’re paid. The one levy continues until your debt is fully paid, other arrangements are made, or the collection period ends. Other payments you receive, such as dividends and payments on promissory notes, are also subject to seizure. However, the seizure only reaches the payments due or the right to future payments as of the date of the levy.

• Your bank account Seizure of the funds in your bank account will include funds available for withdrawal up to the amount of the seizure. After the levy is issued, the bank will hold the available funds and give you 21 days to resolve any disputes about who owns the account before sending us the money. After 21 days, the bank will send us your money, and any interest earned on that amount, unless you have resolved the issue in another way.

• Your federal payments As an alternative to the levy procedure used for other payments such as dividends and promissory notes, certain federal payments may be systemically seized through the Federal Payment Levy Program in order to pay your tax debt. Under this program, we can generally seize up to 15% of your federal payments (up to 100% of payments due to a vendor for goods or services sold or leased to the federal government). We will serve the levy once, not each time you are paid. The levy continues until your debt is fully paid, other arrangements are made, the collection period ends, or the IRS releases the levy. The federal payments that can be seized in this program include, but aren’t limited to, federal retirement annuity income from the Office of Personnel Management, Social Security benefits under Title II of the Social Security Act (OASDI), and federal contractor/vendor payments.

• Your house, car, or other property If we seize your house or other property, we will sell your interest in the property and apply the proceeds (after the costs of the sale) to your tax debt. Prior to selling your property, we will calculate a minimum bid price. We will also provide you with a copy of the calculation and give you an opportunity to challenge the fair market value determination. We will then provide you with the notice of sale and announce the pending sale to the public, usually through local newspapers or flyers posted in public places. After giving public notice, we will generally wait 10 days before selling your property. Money from the sale pays for the cost of seizing and selling the property and, finally, your tax debt. If there’s money left over from the sale after paying off your tax debt, we will tell you how to get a refund.

Property that can’t be seized (“levied”)Certain property is exempt from seizure. For example, we can’t seize the following: unemployment benefits, certain annuity and pension benefits, certain service-connected disability payments, workers compensation, certain public assistance payments, minimum weekly exempt income, assistance under the Job Training Partnership Act, and income for court-ordered child support payments.

We also can’t seize necessary schoolbooks and clothing, undelivered mail, certain amounts worth of fuel, provisions, furniture, personal effects for a household, and certain amounts worth of books and tools for trade, business, or professions. There are also limitations on our ability to seize a primary residence and certain business assets.

Lastly, we can’t seize your property unless we expect net proceeds to help pay off your tax debt.

How to appeal a proposed seizure (“levy”)You can request a Collection Due Process hearing within 30 days from the date of your Notice of Intent to Levy and Notice of Your Right to a Hearing. Send your request to the address on your notice. For more information, see Form 12153, Request for a Collection Due Process or Equivalent Hearing. At the conclusion of your hearing, the Office of Appeals will provide a determination. You’ll have 30 days after the determination to challenge it in the U.S. Tax Court. If Collection Due Process rights aren’t available for your case, you may have other appeal options, such as the Collection Appeals Program.

Reasons we “release” a levy The Internal Revenue Code specifically provides that we must release a levy if we determine that:

• You paid the amount you owe,• The period for collection ended prior to the levy being issued,• It will help you pay your taxes,• You enter into an Installment Agreement and the terms of the

agreement don’t allow for the levy to continue,

7

Publication 594 The IRS Collection Process

• The levy creates an economic hardship, meaning we’ve determined the levy prevents you from meeting basic, reasonable living expenses, or

• The value of the property is more than the amount owed and releasing the levy won’t hinder our ability to collect the amount owed.

We will also release a levy if it was issued improperly. For example, we will release a levy if it was issued:

• Against property exempt from seizure,• Prematurely,• Before we sent you the required notice,• While you were in bankruptcy and an automatic stay was in

effect,• Where the expenses of seizing and selling the levied property

would be greater than the fair market value of the property,• While an Installment Agreement request, Innocent Spouse Relief

request, or Offer in Compromise was being considered or had been accepted and was in effect, or

• While the Office of Appeals or Tax Court was considering a collection due process case and the levy wasn’t a Disqualified Employment Tax Levy to collect employment taxes, a state refund, a jeopardy levy, or to collect the tax debt of federal contractor.

• While the Office of Appeals or Tax Court is considering an appeal of the denial of innocent spouse relief.

Reasons we may return seized (“levied”) propertyWe may return your property if:

• Its seizure was premature,• Its seizure was in violation of the law,• Returning the seized property will help our collection of your

debt,• You enter into an Installment Agreement to satisfy the liability for

which the levy was made, unless the Agreement does not allow for the return of previously levied upon property.

• We didn’t follow IRS procedures, or• It’s in your best interest and in the best interest of the

government.

We may return property at any time if the property has not been sold. If we decided to return your property, but it’s already sold, we will give you the money we received from the sale. You can file a request for return of seized money or money from the sale of seized proper, generally up to 9 months after the seizure.

How to recover seized (“levied”) property that’s been soldTo recover your real estate, you (and anyone with interest in the property) may recoup it within 180 days of the sale by paying the purchaser what they paid, plus interest at 20% annually.

If your property has been seized (“levied”) to collect tax owed by someone else, you may appeal the seizure under the Collection Appeals Program or file a claim under Internal Revenue Code section 6343(b), generally within 9 months of the seizure, or you may file a suit under Internal Revenue Code section 7426 for the return of the wrongfully seized property, generally within 9 months of the seizure. You may also appeal the denial of the request to return the wrongfully seized property under the Collection Appeals Program. For more information, see Publication 4528, Making an Administrative Wrongful Levy Claim under Internal Revenue Code section 6343(b).

How to recover economic damagesIf we wrongfully seized your property, we lost or misplaced your payment, or there was a direct debit Installment Agreement processing error and you incurred bank charges, we may reimburse you for charges you paid. For more information, see Form 8546, Claim for Reimbursement of Bank Charges. If your claim is denied,

you can sue the federal government for economic damages.

If we intentionally or negligently didn’t follow Internal Revenue law while collecting your taxes, or you’re not the taxpayer and we wrongfully seized your property, you may be entitled to recover economic damages. Mail your written administrative claim to the attention of the Advisory Group Manager for your area at the address listed in Publication 4235, Collection Advisory Group Addresses. If you’ve filed a claim and your claim is denied, you can sue the federal government, but not the IRS employee, for economic damages.

Summons: Used to secure informationIf we’re having trouble gathering information to determine or collect taxes you owe, we may serve a summons. A summons legally compels you or a third party to meet with an officer of the IRS and provide information, documents and/or testimony.

If you’re responsible for a tax liability and we serve a summons on you, you may be required to:• Testify,• Bring books and records to prepare a tax return, and/or• Produce documents to prepare a Collection Information

Statement, Form 433-A or Form 433-B.

If you can’t make your summons appointment, immediately call the number listed on your notice. If you don’t call us and don’t attend your appointment, we may sue you in federal district court to require you to comply with the summons.

If we serve a third-party summons to determine your tax liability, you’ll receive a notice indicating that we’re contacting a third party. Third parties can be financial institutions, record keepers, or people with information relevant to your case. We won’t review their information or receive testimony until the end of the 23rd day after the notice was given. You also have the right to:

• Petition to reject (“quash”) the summons before the end of the 20th day after the date of the notice, or

• Petition to intervene in a suit to enforce a summons to which the third party didn’t comply.

If we issue a third-party summons to collect taxes you already owe, you won’t receive notice or be able to petition to reject or intervene in a suit to enforce the summons.

Information for employers: Collection of employment taxAbout employment taxesEmployment taxes are the amount you must withhold from your employees for their income tax and Social Security/Medicare tax (trust fund taxes) plus the amount of Social Security/Medicare tax you pay for each employee. Federal unemployment taxes are also considered employment taxes.

Employment taxes are incurred at the time you pay wages and generally paid in semi-weekly or monthly deposits. You must use electronic funds transfer to make all federal tax deposits, generally through the Electronic Federal Tax Payment System (EFTPS). See Publication 966, Electronic Federal Tax Payment System: A Guide To Getting Started.

What we will do if you don’t pay your employment taxes:• Assess a failure to deposit penalty, up to 15% of the amount not

deposited in a timely manner.• We may propose a Trust Fund Recovery Penalty assessment

against the individuals responsible for failing to pay the trust fund taxes.

8

Publication 594 The IRS Collection Process

About trust fund taxesTrust fund taxes are the income tax, Social Security tax, and Medicare tax (trust fund taxes) withheld from the employee’s wages. They are called trust fund taxes because the employer holds these funds “in trust” for the government until it submits them in a federal tax deposit. Certain excise taxes are also considered trust fund taxes because they are collected and held in trust for the government until submitted in a federal tax deposit. For more information, see Publication 510, Excise Taxes.

To encourage prompt payment of withheld employment taxes and collected excise taxes, Congress has passed a law that provides for the Trust Fund Recovery Penalty.

For more information on employment taxes or trust fund taxes, see Publication 15, Circular E, Employer’s Tax Guide.

Trust Fund Recovery Penalty The Trust Fund Recovery Penalty is a penalty that is assessed personally against the individual or individuals who were responsible for paying the trust fund taxes, but who willfully did not do so. The amount of the penalty is equal to the amount of the unpaid trust fund taxes. For additional information, please see Notice 784, Could You be Personally Liable for Certain Unpaid Federal Taxes? or visit http://www.irs.gov/Businesses/Small-Businesses-&-Self -Employed/Employment-Taxes-and-the-Trust-Fund-Recovery -Penalty-TFRP.

If the Trust Fund Recovery Penalty is proposed against you, you’ll receive a Letter 1153 and Form 2751, Proposed Assessment of Trust Fund Recovery Penalty.

If you agree with the penalty, sign and return Form 2751 within 60 days from the date of the letter. To avoid the assessment of the Trust Fund Recovery Penalty, you may also pay the trust fund taxes personally.

If you disagree with the penalty, you have 10 days from the date of the letter to let us know that you don’t agree with the proposed assessment, have additional information to support your case, or want to try to resolve the matter informally. If you can’t resolve the disagreement with us, you have 60 days from the date of the Letter 1153 to appeal with the Office of Appeals. For more information, see Publication 5, Your Appeal Rights and How to Prepare a Protest if You Don’t Agree.

If you don’t respond to the letter, we will assess the penalty amount against you personally and begin the collection process to collect it. We may assess this penalty against a responsible person regardless of whether the company is still in business.

Additional informationInnocent Spouse ReliefGenerally, both you and your spouse are responsible, jointly and individually, for paying any tax, interest, or penalties on your joint return. If you believe your current or former spouse should be solely responsible for an incorrect item or an underpayment of tax on your joint tax return, you may be eligible for Innocent Spouse Relief. This could change the amount you owe, or you may be entitled to a refund. You must submit Form 8857, Request for Innocent Spouse Relief, no later than two years from the date of our first attempt to collect the outstanding debt, except for requests for equitable relief under Internal Revenue Code section 6015(f). For additional information, see Publication 971, Innocent Spouse Relief

Representation during the collection processDuring the collection process, or an appeal before the IRS Office of Appeals you can be represented by yourself, an attorney, a certified public accountant, an enrolled agent, an immediate family member, or any person enrolled to practice before the IRS. If you’re a business, full-time employees, general partners, or bona fide officers

can also represent you.

To have your representative appear before us, contact us on your behalf, and/or receive your confidential material, file Form 2848, Power of Attorney and Declaration of Representative.

To authorize someone to receive or inspect confidential material, file Form 8821, Tax Information Authorization.

Sharing your tax informationDuring the collection process, we’re authorized to share your tax information in some cases with city and state tax agencies, the Department of Justice, federal agencies, people you authorize to represent you, and certain foreign governments (under tax treaty provisions).

We may contact a third partyThe law allows us to contact others (such as neighbors, banks, employers, or employees) to investigate your case. You have the right to request a list of third parties contacted about your case.

Past Due Tax ReturnsFile all tax returns that are due, regardless of whether or not you can pay in full. File a past due return at the same location where you would file an on-time return.

If you do not voluntarily file your individual income tax return you risk losing your refund and we may file a substitute return for you. This return might not give you credit for deductions and exemptions you may be entitled to receive. We may send you a Notice of Deficiency proposing a tax assessment. Filing a past due return after the Notice of Deficiency was sent does not extend the 90 day period for filing a petition to the United States Tax Court. However, the past due return will be considered in determining whether there will be a reduction in the amount of tax increase previously proposed in the Notice of Deficiency. If you do not file a petition in Tax Court and a tax increase has been determined, we will proceed with our proposed assessment as a substitute return. If the IRS files a substitute return, it is still in your best interest to file your own tax return to take advantage of any exemptions, credits and deductions you are entitled to receive. The IRS will generally adjust your account to reflect the correct figures.

Notice CP11ANotice date August 9, 2010Social Security number

• Make your check or money order payable to the United States Treasury.• Write your Social Security number ), the tax year (2007), and the form

number (1040) on your payment and any correspondence.Payment

INTERNAL REVENUE SERVICE

Amount due by August 30, 2010

Department of the TreasuryInternal Revenue Service

Notice CP11ATax Year 2007Notice date August 9, 2010Social Security numberTo contact us PhoneYour Caller IDPage 1 of 5

Changes to your 2007 Form 1040

Amount due:We believe there’s a miscalculation on your2007 Form 1040, which affects the followingarea of your return:

• Earned Income Tax Credit

We made changes to your return that correctthis error. As a result, you owe

Billing SummaryTax you owedPayments you madeFailure-to-file penaltyFailure-to-pay penaltyInterest chargesAmount due by August 30, 2010

What you need to do immediately Review this notice, and compare our changes to the information on your tax return.If you agree with the changes we made• Pay the amount due of by August 30, 2010 to avoid additional penalty

and interest charges.Continued on back…

Notice CP11ANotice date August 9, 2010Social Security number

If your address has changed, please call or visit www.irs.gov.

Contact information Please check here if you've included any correspondence. Write your Social Securitynumber ), the tax year (2007), and the form number (1040) on anycorrespondence.

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INTERNAL REVENUE SERVICE

Primary phone Best time to call Secondary phone Best time to call

Notice CP11ATax Year 2007Notice date August 9, 2010Social Security numberPage 2 of 5

What you need to do immediately — continued If you agree with the changes we made—continued• If you can’t pay the amount due, pay as much as you can now and make payment

arrangements that allow you to pay off the rest over time. Visit www.irs.gov andsearch for keyword “tax payment options” for more information about:- Installment and payment agreements—download required forms or save time and

money by applying online if you qualify- Automatic deductions from your bank account- Payroll deductions- Credit card paymentsOr, call us at to discuss your options.

If you don’t agree with the changes• Call to review your account. You can also contact us by mail. Fill

out the Contact information section, detach, and send it to us with anycorrespondence or documentation.

• If you contact us in writing within 60 days of the date of this notice, we will reversethe change we made to your account. However, if you are unable to provide usadditional information that justifies the reversal and we believe the reversal is inerror, we will forward your case for audit. This step gives you formal appeal rights,including the right to appeal our decision in court before you have to pay theadditional tax. After we forward your case, the audit staff will contact you within 5to 6 weeks to fully explain the audit process and your rights. If you do not contactus within the 60-day period, you will lose your right to appeal our decision beforepayment of tax.

• If you do not contact us within 60 days, the change will not be reversed and youmust pay the additional tax. You may then file a claim for refund. You must submitthe claim within 3 years of the date you filed the tax return, or within 2 years of thedate of your last payment for this tax.

• If we don’t hear from you, we’ll assume you agree with the information in thisnotice.

Notice CP11A

Tax Year 2007Notice date August 9, 2010Social Security numberPage 3 of 5

If we don’t hear from you • If you don’t pay by August 30, 2010, interest will increase, and additionalpenalties may apply.

Changes to your 2007 tax return Information was changed because of the following:• We have changed the amount of your Earned Income Credit because one or more a

social security number, taxpayer identification number, last name, or date of birthwas not correct or was missing. Because of recent tax law changes affecting theearned income credit and dependent exemptions, you may no longer be eligible forthe earned income credit or to claim the exemption.

• We didn’t allow your personal exemption on Line 6a and Earned Income Credit (EIC)on your tax return. Your Social Security Number (SSN) or last name doesn’t matchour records or the records provided by the Social Security Administration.

NOTE: To be eligible for EIC, you, your spouse, and qualifying child or children mustuse a correct name and SSN issued by the Social Security Administration.

If you, your spouse, or any of your dependents do not qualify for an SSN, you mayobtain an Individual Taxpayer Identification Number (ITIN) issued by the InternalRevenue Service by filing Form W-7, Application for IRS Individual TaxpayerIdentification Number. This number will allow you to file your return and to claim anexemption but you will be ineligible to claim the Earned Income Credit. You may call

to get Form W-7 or download it from our website at www.irs.gov.

Your tax calculations Description Your calculations IRS calculations

Adjusted gross income $Taxable incomeTotal tax

Your payments and credits Description IRS calculations

Income tax withheldEstimated tax paymentsOther creditsOther paymentsTotal payments and credits

Penalties We are required by law to charge any applicable penalties.

Failure-to-file Description Amount

Total failure-to-file

When you file your tax return after the due date, we charge a penalty of up to 5% of theunpaid tax per month for no more than 5 months or up to 25% of the unpaid amount. Ifthe return is more than 60 days late, we may charge the minimum of $100 or 100% ofthe unpaid tax, whichever is less, for tax returns due before December 31, 2008. Wecount part of a month as a full month. (Internal Revenue Code section 6651)

Failure-to-pay

Notice CP11A

Tax Year 2007Notice date August 9, 2010Social Security numberPage 4 of 5

Date received Months late Unpaid Amount Penalty rate Amount

08/15/2010 28 0.50%

When you pay your taxes after the due date, we charge a penalty of 0.5% of theunpaid amount due per month, up to 25% of the amount due. We count part of amonth as a full month. (Internal Revenue Code section 6651)

Removal or reduction of penalties We understand that circumstances—such as economic hardship, a family member’sdeath, or loss of financial records due to natural disaster—may make it difficult for youto meet your taxpayer responsibility in a timely manner.

If you would like us to consider removing or reducing any of your penalty charges,please do the following:• Identify which penalty charges you would like us to reconsider (e.g., 2005 late filing

penalty).• For each penalty charge, explain why you believe it should be reconsidered.• Sign your statement, and mail it to us.

We will review your statement and let you know whether we accept your explanationas reasonable cause to reduce or remove the penalty charge(s).

Removal of penalties due to erroneous writtenadvice from the IRS

If you were penalized based on written advice from the IRS, we will remove the penaltyif you meet the following criteria:• If you asked the IRS for written advice on a specific issue

You gave us complete and accurate information• You received written advice from us• You relied on our written advice and were penalized based on that advice

To request removal of penalties based on erroneous written advice from us, submit acompleted Claim for Refund and Request for Abatement (Form 843) to the IRS servicecenter where you filed your tax return. For a copy of the form or to find your IRS servicecenter, go to www.irs.gov or call .

Interest chargesPeriod Days Interest rate Interest rate factor Amount due Interest change

04/15/2008 - 06/30/2008 76 6.0% 0.01253591906/30/2008 - 09/30/2008 92 5.0% 0.01264675009/30/2008 - 12/31/2008 92 6.0% 0.01519501912/31/2008 - 03/31/2009 90 5.0% 0.01240422503/31/2009 - 09/30/2009 183 4.0% 0.02025612209/30/2009 - 12/31/2009 92 4.0% 0.01013263012/31/2009 - 06/30/2010 181 4.0% 0.02003254106/30/2010 - 08/09/2010 40 4.0% 0.004392942Total interest

We are required by law to charge interest on unpaid tax from the date the tax returnwas due to the date the tax is paid in full. The interest is charged as long as there is anunpaid amount due, including penalties, if applicable. (Internal Revenue Code section6601)

We multiply your unpaid tax, penalties, and interest (the amount due) by the interestrate factor to determine the interest due each quarter.

Notice CP11A

Tax Year 2007Notice date August 9, 2010Social Security numberPage 5 of 5

Additional Interest Charges If the amount you owe is $100,000 or more, please make sure that we receive yourpayment within 10 work days from the date of your notice. If the amount you owe isless than $100,000, please make sure that we receive your payment within 21calendar days from the date of your notice. If we don’t receive full payment withinthese time frames, the law requires us to charge interest until you pay the full amountyou owe.

Additional information • Visit www.irs.gov/cp11.• For tax forms, instructions, and publications,visit www.irs.gov or call 1-800-TAX-

FORM (1-800-829-3676).• Did you e-file your tax return? Electronically filed returns are less likely to have math

errors resulting in notices such as this one. It’s free to file your taxes electronically.Go to www.irs.gov/efile for information and instructions.

• Keep this notice for your records.If you need assistance, please don’t hesitate to contact us.

Department of Treasury Internal Revenue Service

Notice CP21A Notice date March 2, 2009 Social Security number

• Make your check or money order payable to the United States Treasury. • Write your Social Security number ), the tax year (2004), and the form number (1040) on your payment and any correspondence.

Notice CP21A Tax Year 2004 Notice date March 2, 2009 Social Security number To contact us Your Caller ID Page 1 of 3

INTERNAL REVENUE SERVICE

Changes to your 2004 Form 1040

Amount due: $24.60

Based on the information you provided, we changed your 2004 Form 1040 to correct your: • Filing status to head of household • Total exemption amount As a result, you owe $24.60.

Billing Summary

Amount you owed $1,076.63 Decrease in tax – 963.00 Decrease in interest – 89.03 Amount due by March 23, 2009 $24.60

What you need to do immediately If you agree with the changes we made • Pay the amount due of $24.60 by March 23, 2009 to avoid

additional penalty and interest charges.

Amount due March 23, 2009 $24.60

Continued on back…

Payment

Notice CP21A Tax Year 2004 Notice date March 2, 2009 Social Security number Page 2 of 3

What you need to do immediately—continued If you agree with the changes we made—continued • If you can’t pay the amount due, pay as much as you can

now and make payment arrangements that allow you to pay off the rest over time. Visit www.irs.gov and search for keyword “tax payment options” for more information about: – Installment and payment agreements—download required

forms or save time and money by applying online if you qualify

– Automatic deductions from your bank account – Payroll deductions – Credit card payments Or, call us at to discuss your options.

If you don’t agree with the changes • Call to review your account. You can also

contact us by mail. Fill out the Contact information section, detach, and send it to us with any correspondence or documentation.

• If we don’t hear from you, we’ll assume you agree with the information in this notice.

If you’ve already paid your balance in full within the past 14 days or made payment arrangements, please disregard this notice.

If we don’t hear from you • If you don’t pay $24.60 by March 23, 2009, interest will increase, and additional penalties may apply.

Contact information

Notice CP21A Notice date March 2, 2009 Social Security number

If your address has changed, please call or visit www.irs.gov. Please check here if you’ve included any correspondence. Write your

Social Security number ( , the tax year (2006), and the form number (1040) on any correspondence.

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Primary phone Best time to call Secondary phone Best time to call

INTERNAL REVENUE SERVICE

Notice CP21A Tax Year 2004 Notice date March 2, 2009 Social Security number Page 3 of 3

Additional information • Visit www.irs.gov/cp21a. • For tax forms, instructions, and publications, visit www.irs.gov

or call 1-800-TAX-FORM (1-800-829-3676). • Keep this notice for your records. If you need assistance, please don’t hesitate to contact us.

CP22E

2010Department of the TreasuryInternal Revenue Service

NoticeTax YearNotice date February 10, 2014

Social Security numberIRS

IRS

Payment

To contact usYour Caller IDPage 1 of 3

Billing Summary

Account balance before this change Increase in taxDecrease in creditIncrease in interestDecrease in interest we owe youAmount due by March 3, 2014

If you agree with the changes we madePay the amount due of 8 by March 3, 2014 to avoid additional penalty andinterest charges.

Changes to your 2010 Form 1040

Amount due: As a result of your recent audit, we changedyour 2010 Form 1040. Please see your copy ofthe audit report for a detailed explanation ofthe changes.

As a result, you owe

What you need to do immediately

Continued on back...

Make your check or money order payable to the United States Treasury.Write your Social Security number ), the tax year (2010), and the formnumber (1040) on your payment and any correspondence.

Amount due by March 3, 2014

Notice CP22E

Notice date February 10, 2014

Social Security number

INTERNAL REVENUE SERVICE

Notice

CP22E

Tax Year

2010

Notice date February 10, 2014

Social Security number Page 2 of 3

What you need to do immediately —continued

If you agree with the changes we made — continuedIf you can't pay the amount due, pay as much as you can now and make paymentarrangements that allow you to pay off the rest over time. Visitwww.irs.gov/Payments for more information about:

Installment and payment agreements—download required forms or save timeand money by applying online if you qualifyAutomatic payment deductions from your bank accountPayroll deductionsCredit card payments

Or, call us at 1-800-829-0922 to discuss your options. If you don't agree with the changes

Call 1-800-829-0922 to review your account. You can also contact us by mail. Fillout the Contact information section, detach, and send it to us with anycorrespondence or documentation.If we don't hear from you, we'll assume you agree with the information in thisnotice.

If you've already paid your balance in full within the past 14 days or made paymentarrangements, please disregard this notice.

What you need to do immediately —continued

If we don't hear from you • If you don't pay $ by March 3, 2014, interest will increase, and additionalpenalties may apply.

IRS

Contact information

Notice CP22E

Notice date February 10, 2014

Social Security number

If your address has changed, please call 1-800-829-0922 or visit www.irs.gov .Please check here if you've included any correspondence. Write your Social Securitynumber , the tax year (2010), and the form number (1040) on anycorrespondence.

INTERNAL REVENUE SERVICE

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Primary phone Best time to call Secondary phone Best time to call

Notice CP22E Tax Year 2010 Notice date February 10, 2014 Social Security number

Page 3 of 3

Interest charges We are required by law to charge interest on unpaid tax from the date the tax returnwas due to the date the tax is paid in full. The interest is charged as long as there is anunpaid amount due, including penalties, if applicable. (Internal Revenue Code section6601)Description Amount Total interest

The table below shows the rates used to calculate the interest on your unpaid amountdue. For a detailed calculation of your interest call 1-800-829-0922.Period Interest rate

April 1, 2009 through December 31, 2010 4%January 1, 2011 through March 31, 2011 3%April 1, 2011 through September 30, 2011 4%Beginning October 1, 2011 3%

Additional interest charges If the amount you owe is $100,000 or more, please make sure that we receive yourpayment within 10 work days from the date of your notice. If the amount you owe isless than $100,000, please make sure that we receive your payment within 21calendar days from the date of your notice. If we don't receive full payment withinthese time frames, the law requires us to charge interest until you pay the full amountyou owe.

Additional information Visit www.irs.gov/cp22eFor tax forms, instructions, and publications, visit www.irs.gov or call1-800-TAX-FORM (1-800-829-3676).Keep this notice for your records.

If you need assistance, please don't hesitate to contact us.

Form 433-A(Rev. December 2012)

Department of the Treasury Internal Revenue Service

Collection Information Statement for Wage Earners and Self-Employed Individuals

Wage Earners Complete Sections 1, 2, 3, 4, and 5 including the signature line on page 4. Answer all questions or write N/A if the question is not applicable.

Self-Employed Individuals Complete Sections 1, 3, 4, 5, 6 and 7 and the signature line on page 4. Answer all questions or write N/A if the question is not applicable.

For Additional Information, refer to Publication 1854, "How To Prepare a Collection Information Statement."

Include attachments if additional space is needed to respond completely to any question.Name on Internal Revenue Service (IRS) Account Social Security Number SSN on IRS Account Employer Identification Number EIN

Section 1: Personal Information1a Full Name of Taxpayer and Spouse (if applicable)

1b Address (Street, City, State, ZIP code) (County of Residence)

1c Home Phone( )

1d Cell Phone( )

1e Business Phone( )

1f Business Cell Phone( )

2a Marital Status: Married Unmarried (Single, Divorced, Widowed)

2b Name, Age, and Relationship of dependent(s)

Social Security No. (SSN) Date of Birth (mmddyyyy) Driver's License Number and State

3a Taxpayer

3b SpouseSection 2: Employment Information for Wage Earners

If you or your spouse have self-employment income instead of, or in addition to wage income, complete Business Information in Sections 6 and 7.Taxpayer

4a Taxpayer's Employer Name

4b Address (Street, City, State, and ZIP code)

4c Work Telephone Number( )

4d Does employer allow contact at work

Yes No4e How long with this employer

(years) (months)

4f Occupation

4g Number of withholding allowances claimed on Form W-4

4h Pay Period:

Weekly

Monthly

Bi-weekly

Other

Spouse

5a Spouse's Employer Name

5b Address (Street, City, State, and ZIP code)

5c Work Telephone Number( )

5d Does employer allow contact at work

Yes No5e How long with this employer

(years) (months)

5f Occupation

5g Number of withholding allowances claimed on Form W-4

5h Pay Period:

Weekly

Monthly

Bi-weekly

OtherSection 3: Other Financial Information (Attach copies of applicable documentation)

6 Are you a party to a lawsuit (If yes, answer the following) Yes No

Plaintiff Defendant

Location of Filing Represented by Docket/Case No.

Amount of Suit

$

Possible Completion Date (mmddyyyy) Subject of Suit

7 Have you ever filed bankruptcy (If yes, answer the following) Yes No

Date Filed (mmddyyyy) Date Dismissed (mmddyyyy) Date Discharged (mmddyyyy) Petition No. Location Filed

8 In the past 10 years, have you lived outside of the U.S for 6 months or longer (If yes, answer the following) Yes NoDates lived abroad: from (mmddyyyy) To (mmddyyyy)

9a Are you the beneficiary of a trust, estate, or life insurance policy (If yes, answer the following) Yes No

Place where recorded: EIN:Name of the trust, estate, or policy Anticipated amount to be received

$

When will the amount be received

9b Are you a trustee, fiduciary, or contributor of a trust Yes NoName of the trust: EIN:

10 Do you have a safe deposit box (business or personal) (If yes, answer the following) Yes No

Location (Name, address and box number(s)) Contents Value

$

www.irs.gov Cat. No. 20312N Form 433-A (Rev.12-2012)

11 In the past 10 years, have you transferred any assets for less than their full value (If yes, answer the following) Yes No

List Asset(s) Value at Time of Transfer

$

Date Transferred (mmddyyyy) To Whom or Where was it Transferred

Form 433-A (Rev. 12-2012) Page 2Section 4: Personal Asset Information for All Individuals

12 CASH ON HAND Include cash that is not in a bank Total Cash on Hand $PERSONAL BANK ACCOUNTS Include all checking, online and mobile (e.g., PayPal) accounts, money market accounts, savings accounts, and stored value cards (e.g., payroll cards, government benefit cards, etc.).

Total Available Cash (Subtract amounts on line 16f from line 16e and include amounts from any attachments)

Form 433-A (Rev. 12-2012)

Type of AccountFull Name & Address (Street, City, State, ZIP code) of Bank,

Savings & Loan, Credit Union, or Financial InstitutionAccount Number

Account Balance

As of

mmddyyyy

13a $

13b $

13c $

13d Total Cash (Add lines 13a through 13c, and amounts from any attachments) $

INVESTMENTS Include stocks, bonds, mutual funds, stock options, certificates of deposit, and retirement assets such as IRAs, Keogh, and 401(k) plans. Include all corporations, partnerships, limited liability companies, or other business entities in which you are an officer, director, owner, member, or otherwise have a financial interest.

Type of Investment or Financial Interest

Full Name & Address (Street, City, State, ZIP code) of Company

Current ValueLoan Balance (if applicable)

As ofmmddyyyy

Equity Value minus Loan

14a

Phone $ $ $ 14b

Phone $ $ $ 14c

Phone $ $ $

14d Total Equity (Add lines 14a through 14c and amounts from any attachments) $

AVAILABLE CREDIT Include all lines of credit and bank issued credit cards. Full Name & Address (Street, City, State, ZIP code) of Credit Institution Credit Limit

Amount Owed

As ofmmddyyyy

Available Credit

As ofmmddyyyy

15a

Acct. No $ $ $ 15b

Acct. No $ $ $

15c Total Available Credit (Add lines 15a, 15b and amounts from any attachments) $16a LIFE INSURANCE Do you own or have any interest in any life insurance policies with cash value (Term Life insurance does not have a cash value)

Yes No If yes, complete blocks 16b through 16f for each policy.

16b Name and Address of Insurance Company(ies):

16c Policy Number(s)

16d Owner of Policy

16e Current Cash Value $

16f Outstanding Loan Balance $

$

$

$

$

16g $

Form 433-A (Rev. 12-2012) Page 3

REAL PROPERTY Include all real property owned or being purchased

Purchase Date (mmddyyyy)

Current Fair Market Value

(FMV)

Current Loan Balance

Amount of Monthly Payment

Date of Final Payment

(mmddyyyy)

Equity FMV Minus Loan

17a Property Description

$ $ $ $Location (Street, City, State, ZIP code) and County Lender/Contract Holder Name, Address (Street, City, State, ZIP code), and Phone

Phone

17b Property Description

$ $ $ $Location (Street, City, State, ZIP code) and County Lender/Contract Holder Name, Address (Street, City, State, ZIP code), and Phone

Phone

17c Total Equity (Add lines 17a, 17b and amounts from any attachments) $

PERSONAL VEHICLES LEASED AND PURCHASED Include boats, RVs, motorcycles, all-terrain and off-road vehicles, trailers, etc.

Description (Year, Mileage, Make/Model, Tag Number, Vehicle Identification Number)

18a Year Make/Model

Mileage License/Tag Number

Vehicle Identification Number

Purchase/Lease Date (mmddyyyy)

Current Fair Market Value

(FMV)

$

Current Loan Balance

$

Amount of Monthly Payment

$

Date of Final Payment

(mmddyyyy)

Equity FMV Minus Loan

$Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

Phone18b Year Make/Model

Mileage License/Tag Number

Vehicle Identification Number

$ $ $ $Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

Phone

18c Total Equity (Add lines 18a, 18b and amounts from any attachments) $

Purchase/Lease Date (mmddyyyy)

Current Fair Market Value

(FMV)

Current Loan Balance

Amount of Monthly Payment

Date of Final Payment

(mmddyyyy)

Equity FMV Minus Loan

19a Property Description

$ $ $ $Location (Street, City, State, ZIP code) and County Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

Phone

19b Property Description

$ $ $ $Location (Street, City, State, ZIP code) and County Lender/Lessor Name, Address (Street, City, State, ZIP code), and Phone

Phone

19c Total Equity (Add lines 19a, 19b and amounts from any attachments) $

Form 433-A (Rev. 12-2012)

PERSONAL ASSETS Include all furniture, personal effects, artwork, jewelry, collections (coins, guns, etc.), antiques or other assets. Include intangible assets such as licenses, domain names, patents, copyrights, mining claims, etc.

Form 433-A (Rev. 12-2012) Page 4

If you are self-employed, sections 6 and 7 must be completed before continuing.

Section 5: Monthly Income and ExpensesMonthly Income/Expense Statement (For additional information, refer to Publication 1854.)

Total Income

Source Gross Monthly

20 Wages (Taxpayer) 1 $

21 Wages (Spouse) 1 $

22 Interest - Dividends $

23 Net Business Income 2 $

24 Net Rental Income 3 $

25 Distributions (K-1, IRA, etc.) 4 $

26 Pension (Taxpayer) $

27 Pension (Spouse) $

28 Social Security (Taxpayer) $

29 Social Security (Spouse) $

30 Child Support $

31 Alimony $

Other Income (Specify below) 5

32 $

33 $

34 Total Income (add lines 20-33) $

Total Living Expenses

Expense Items 6 Actual Monthly

35 Food, Clothing and Misc. 7 $

36 Housing and Utilities 8 $

37 Vehicle Ownership Costs 9 $

38 Vehicle Operating Costs 10 $

39 Public Transportation 11 $

40 Health Insurance $

41 Out of Pocket Health Care Costs 12 $

42 Court Ordered Payments $

43 Child/Dependent Care $

44 Life Insurance $

45 Current year taxes (Income/FICA) 13 $

46 Secured Debts (Attach list) $

47 Delinquent State or Local Taxes $

48 Other Expenses (Attach list) $

49 Total Living Expenses (add lines 35-48) $

50 Net difference (Line 34 minus 49) $

IRS USE ONLY

Allowable Expenses

1 Wages, salaries, pensions, and social security: Enter gross monthly wages and/or salaries. Do not deduct tax withholding or allotments taken out of pay, such as insurance payments, credit union deductions, car payments, etc. To calculate the gross monthly wages and/or salaries:

If paid weekly - multiply weekly gross wages by 4.3. Example: $425.89 x 4.3 = $1,831.33

If paid biweekly (every 2 weeks) - multiply biweekly gross wages by 2.17. Example: $972.45 x 2.17 = $2,110.22

If paid semimonthly (twice each month) - multiply semimonthly gross wages by 2. Example: $856.23 x 2 = $1,712.46

2 Net Income from Business: Enter monthly net business income. This is the amount earned after ordinary and necessary monthly business expenses are paid. This figure is the amount from page 6, line 89. If the net business income is a loss, enter “0”. Do not enter a negative number. If this amount is more or less than previous years, attach an explanation.

3 Net Rental Income: Enter monthly net rental income. This is the amount earned after ordinary and necessary monthly rental expenses are paid. Do not include deductions for depreciation or depletion. If the net rental income is a loss, enter “0.” Do not enter a negative number.

4 Distributions: Enter the total distributions from partnerships and subchapter S corporations reported on Schedule K-1, and from limited liability companies reported on Form 1040, Schedule C, D or E. Enter total distributions from IRAs if not included under pension income.

5 Other Income: Include agricultural subsidies, unemployment compensation, gambling income, oil credits, rent subsidies, etc.

6 Expenses not generally allowed: We generally do not allow tuition for private schools, public or private college expenses, charitable contributions, voluntary retirement contributions or payments on unsecured debts. However, we may allow the expenses if proven that they are necessary for the health and welfare of the individual or family or the production of income. See Publication 1854 for exceptions.

7 Food, Clothing and Miscellaneous: Total of food, clothing, housekeeping supplies, and personal care products for one month. The miscellaneous allowance is for expenses incurred that are not included in any other allowable living expense items. Examples are credit card payments, bank fees and charges, reading material, and school supplies.

8 Housing and Utilities: For principal residence: Total of rent or mortgage payment. Add the average monthly expenses for the following: property taxes, homeowner’s or renter’s insurance, maintenance, dues, fees, and utilities. Utilities include gas, electricity, water, fuel, oil, other fuels, trash collection, telephone, cell phone, cable television and internet services.

9 Vehicle Ownership Costs: Total of monthly lease or purchase/loan payments.

10 Vehicle Operating Costs: Total of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, and tolls for one month.

11 Public Transportation: Total of monthly fares for mass transit (e.g., bus, train, ferry, taxi, etc.)

12 Out of Pocket Health Care Costs: Monthly total of medical services, prescription drugs and medical supplies (e.g., eyeglasses, hearing aids, etc.)

13 Current Year Taxes: Include state and Federal taxes withheld from salary or wages, or paid as estimated taxes.

Certification: Under penalties of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is true, correct, and complete.

Taxpayer's Signature Spouse's signature Date

After we review the completed Form 433-A, you may be asked to provide verification for the assets, encumbrances, income and expenses reported. Documentation may include previously filed income tax returns, pay statements, self-employment records, bank and investment statements, loan statements, bills or statements for recurring expenses, etc.

IRS USE ONLY (Notes)

Form 433-A (Rev. 12-2012)

Form 433-A (Rev. 12-2012) Page 5

Sections 6 and 7 must be completed only if you are SELF-EMPLOYED.

Section 6: Business Information51 Is the business a sole proprietorship (filing Schedule C) Yes, Continue with Sections 6 and 7. No, Complete Form 433-B.

All other business entities, including limited liability companies, partnerships or corporations, must complete Form 433-B.Business Name & Address (if different than 1b)52

53 Employer Identification Number 54 Type of Business Is the business a Federal Contractor Yes No

56 Business Website (web address) 57 Total Number of Employees 58 Average Gross Monthly Payroll

59 Frequency of Tax Deposits 60 Does the business engage in e-Commerce (Internet sales) If yes, complete lines 61a and 61b Yes No

PAYMENT PROCESSOR (e.g., PayPal, Authorize.net, Google Checkout, etc.) Name & Address (Street, City, State, ZIP code) Payment Processor Account Number

61a

61b

CREDIT CARDS ACCEPTED BY THE BUSINESS

Credit Card Merchant Account Number Issuing Bank Name & Address (Street, City, State, ZIP code)

62a

62b

62c

63 BUSINESS CASH ON HAND Include cash that is not in a bank. Total Cash on Hand $BUSINESS BANK ACCOUNTS Include checking accounts, online and mobile (e.g., PayPal) accounts, money market accounts, savings accounts, and stored value cards (e.g., payroll cards, government benefit cards, etc.). Report Personal Accounts in Section 4.

Type of Account Full name & Address (Street, City, State, ZIP code) of Bank,Savings & Loan, Credit Union or Financial Institution. Account Number

Account Balance

As ofmmddyyyy

64a $

64b $

64c Total Cash in Banks (Add lines 64a, 64b and amounts from any attachments) $ACCOUNTS/NOTES RECEIVABLE Include e-payment accounts receivable and factoring companies, and any bartering or online auction accounts. (List all contracts separately, including contracts awarded, but not started.) Include Federal, state and local government grants and contracts.

Accounts/Notes Receivable & Address (Street, City, State, ZIP code) Status (e.g., age, factored, other)

Date Due (mmddyyyy)

Invoice Number or Government Grant or Contract Number Amount Due

65a $

65b $

65c $

65d $

65e $

65f Total Outstanding Balance (Add lines 65a through 65e and amounts from any attachments) $

Form 433-A (Rev. 12-2012)

55

Form 433-A (Rev. 12-2012) Page 6

Section 7: Sole Proprietorship Information (lines 67 through 87 should reconcile with business Profit and Loss Statement)

Form 433-A (Rev. 12-2012)

BUSINESS ASSETS Include all tools, books, machinery, equipment, inventory or other assets used in trade or business. Include a list and show the value of all intangible assets such as licenses, patents, domain names, copyrights, trademarks, mining claims, etc.

Purchase/Lease Date (mmddyyyy)

Current Fair Market Value

(FMV)

Current Loan Balance

Amount of Monthly Payment

Date of Final Payment

(mmddyyyy)

Equity FMV Minus Loan

66a Property Description$ $ $ $

Location (Street, City, State, ZIP code) and Country Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code), and Phone

Phone

66b Property Description$ $ $ $

Location (Street, City, State, ZIP code) and Country Lender/Lessor/Landlord Name, Address (Street, City, State, ZIP code), and Phone

Phone

66c Total Equity (Add lines 66a, 66b and amounts from any attachments) $

Section 7 should be completed only if you are SELF-EMPLOYED

Accounting Method Used: Cash Accrual

Income and Expenses during the period (mmddyyyy) to (mmddyyyy)

Total Monthly Business Income

Source Gross Monthly

67 Gross Receipts $

68 Gross Rental Income $

69 Interest $

70 Dividends $

71 Cash Receipts not included in lines 67-70 $

Other Income (Specify below)

72 $

73 $

74 $

75 $

76 Total Income (Add lines 67 through 75) $

Total Monthly Business Expenses (Use attachments as needed)

Expense Items Actual Monthly

77 Materials Purchased 1 $

78 Inventory Purchased 2 $

79 Gross Wages & Salaries $

80 Rent $

81 Supplies 3 $

82 Utilities/Telephone 4 $

83 Vehicle Gasoline/Oil $

84 Repairs & Maintenance $

85 Insurance $

86 Current Taxes 5 $

87 Other Expenses, including installment payments (Specify) $

88 Total Expenses (Add lines 77 through 87) $

89 Net Business Income (Line 76 minus 88) 6 $

Enter the monthly net income amount from line 89 on line 23, section 5. If line 89 is a loss, enter "0" on line 23, section 5. Self-employed taxpayers must return to page 4 to sign the certification.

1 Materials Purchased: Materials are items directly related to the production of a product or service.2 Inventory Purchased: Goods bought for resale.3 Supplies: Supplies are items used in the business that are consumed or used up within one year. This could be the cost of books, office supplies, professional equipment, etc.4 Utilities/Telephone: Utilities include gas, electricity, water, oil, other fuels, trash collection, telephone, cell phone and business internet.

5 Current Taxes: Real estate, excise, franchise, occupational, personal property, sales and employer’s portion of employment taxes.6 Net Business Income: Net profit from Form 1040, Schedule C may be used if duplicated deductions are eliminated (e.g., expenses for business use of home already included in housing and utility expenses on page 4). Deductions for depreciation and depletion on Schedule C are not cash expenses and must be added back to the net income figure. In addition, interest cannot be deducted if it is already included in any other installment payments allowed.

IRS USE ONLY (Notes)

Use the prior 3, 6, 9 or 12 month period to determine your typical business income and expenses.

Provide a breakdown below of your average monthly income and expenses, based on the period of time used above.

Form 433-A (OIC) (Rev. January 2015)

Department of the Treasury — Internal Revenue Service Collection Information Statement for Wage Earners and

Self-Employed Individuals Use this form if you are

► An individual who owes income tax on a Form 1040, U.S. Individual Income Tax Return

► An individual with a personal liability for Excise Tax

► An individual responsible for a Trust Fund Recovery Penalty ► An individual who is personally responsible for a partnership

liability (only if the partnership is submitting an offer)

► An individual who is self-employed or has self-employment income. You are considered to be self-employed if you are in business for yourself, or carry on a trade or business.

Wage earners Complete Sections 1, 2, 3, 7, 8, 9 and the signature line in Section 10. Self-employed individuals Complete Sections 4, 5, 6, in addition to Sections 1, 2 (if applicable), 3, 7, 8, 9 and the signature line in Section 10. Note: Include attachments if additional space is needed to respond completely to any question.

Section 1 Personal and Household Information Last Name First Name Date of Birth (mm/dd/yyyy) Social Security Number

- -Marital status

Unmarried

Married

Home Address (Street, City, State, ZIP Code) Do you:

Own your home Rent

Other (specify e.g., share rent, live with relative, etc.)

County of Residence Primary Phone

( ) -Secondary Phone

( ) -

Fax Number

( ) -

Mailing Address (if different from above or Post Office Box number)

Provide information about your spouse. Spouse's Last Name Spouse's First Name Date of Birth (mm/dd/yyyy)

Provide information for all other persons in the household or claimed as a dependent.

Name Age Relationship Claimed as a dependent on your Form 1040?

Contributes to household income?

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

Social Security Number

- -

Section 2 Employment Information for Wage Earners If you or your spouse have self-employment income (that is you file a Schedule C, E, F, etc.) instead of, or in addition to wage income, you must complete Business Information in Sections 4, 5, and 6.

Your Employer’s Name Employer’s Address (street, city, state, zip code)

Do you have an interest in this business?

Yes No

If yes, check the business interest that applies: Partner Officer

Sole proprietor

Your Occupation How long with this employer

(years) (months)

Spouse’s Employer's Name Employer’s Address (street, city, state, zip code)

Does your spouse have an interest in this business?

Yes No

If yes, check the business interest that applies: Partner Officer

Sole proprietor

Spouse's Occupation How long with this employer

(years) (months)

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 2 of 8

Section 3 Personal Asset Information

Use the most current statement for each type of account, such as checking, savings, money market and online accounts, stored value cards (such as, a payroll card from an employer), investment and retirement accounts (IRAs, Keogh, 401(k) plans, stocks, bonds, mutual funds, certificates of deposit), life insurance policies that have a cash value, and safe deposit boxes. Asset value is subject to adjustment by IRS based on individual circumstances. Enter the total amount available for each of the following (if additional space is needed include attachments).

Round to the nearest dollar. Do not enter a negative number. If any line item is a negative number, enter "0".

Cash and Investments (domestic and foreign)

Cash Checking Savings Money Market/CD Online Account Stored Value Card

Bank Name Account Number

(1a) $

Checking Savings Money Market/CD Online Account Stored Value Card

Bank Name Account Number

(1b) $

Total of bank accounts from attachment (1c) $

Add lines (1a) through (1c) less ($1,000) = (1) $

Investment Account: Stocks Bonds Other

Name of Financial Institution Account Number

Current Market Value

$ X .8 = $

Less Loan Balance

– $ = (2a) $

Investment Account: Stocks Bonds Other

Name of Financial Institution Account Number

Current Market Value

$ X .8 = $

Less Loan Balance

– $ = (2b) $

Total of investment accounts from attachment. [current market value X.8 less loan balance(s)] (2c) $

Add lines (2a) through (2c) = (2) $ Retirement Account: 401K IRA Other

Name of Financial Institution Account Number

Current Market Value

$ X .7 = $

Less Loan Balance

– $ = (3a) $

Retirement Account: 401K IRA Other

Name of Financial Institution Account Number

Current Market Value

$ X .7 = $

Less Loan Balance

– $ = (3b) $

Total of investment accounts from attachment. [current market value X .7 less loan balance(s)] (3c) $

Add lines (3a) through (3c) = (3) $

Cash Value of Life Insurance Policies

Name of Insurance Company Policy Number

Current Cash Value

$

Less Loan Balance

– $ = (4a) $

Total of life insurance policies from attachment

$

Less Loan Balance(s)

– $ = (4b) $

Add lines (4a) through (4b) = (4) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 3 of 8

Section 3 (Continued) Personal Asset Information Real Estate (Enter information about any house, condo, co-op, time share, etc. that you own or are buying) Property Address (Street Address, City, State, ZIP Code) Primary Residence Yes No

Date Purchased

County and Country Date of Final Payment

How title is held (joint tenancy, etc.) Description of Property

Current Market Value

$ X .8 = $

Less Loan Balance (Mortgages, etc.)

– $ (Total Value of Real Estate) = (5a) $

Property Address (Street Address, City, State, ZIP Code) Primary Residence Yes No

Date Purchased

County and Country Date of Final Payment

How title is held (joint tenancy, etc.) Description of Property

Current Market Value

$ X .8 = $

Less Loan Balance (Mortgages, etc.)

– $ (Total Value of Real Estate) = (5b) $

Total value of property(s) from attachment [current market value X .8 less any loan balance(s)] (5c) $

Add lines (5a) through (5c) = (5) $

Vehicles (Enter information about any cars, boats, motorcycles, etc. that you own or lease)

Vehicle Make & Model Year Date Purchased Mileage

Lease

Loan

Name of Creditor Date of Final Payment Monthly Lease/Loan Amount

$

Current Market Value

$ X .8 = $

Less Loan Balance (Mortgages, etc.)

– $ Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6a) $

Subtract $3,450 from line (6a). If line (6a) less line (6b) is a negative number, enter "0". (6b) $

Vehicle Make & Model Year Date Purchased Mileage

Lease

Loan

Name of Creditor Date of Final Payment Monthly Lease/Loan Amount

$

Current Market Value

$ X .8 = $

Less Loan Balance (Mortgages, etc.)

– $ Total value of vehicle (if the vehicle is leased, enter 0 as the total value) = (6c) $

If you are filing a joint offer, subtract $3,450 from line (6c). If line (6c) less line (6d) is a negative number, enter "0". (6d) $

Total value of vehicles listed from attachment [current market value X .8 less any loan balance(s)] (6e) $

Total lines (6a) through (6e) = (6) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 4 of 8 Section 3 (Continued) Personal Asset Information

Other valuable items (artwork, collections, jewelry, items of value in safe deposit boxes, interest in a company or business that is not publicly traded, etc.)

Description of asset:

Current Market Value

$ X .8 = $

Less Loan Balance

– $ = (7a) $

Description of asset:

Current Market Value

$ X .8 = $

Less Loan Balance

– $ = (7b) $

Total value of valuable items listed from attachment [current market value X .8 less any loan balance(s)] (7c) $

Add lines (7a) through (7c) = (7) $

Do not include amount on the lines with a letter beside the number. Round to the nearest whole dollar.

Do not enter a negative number. If any line item is a negative, enter "0" on that line. Add lines (1) through (7) and enter the amount in Box A =

Box A Available Individual Equity in Assets

$

NOTE: If you or your spouse are self-employed, Sections 4, 5, and 6 must be completed before continuing with Sections 7 and 8.

Section 4 Self-Employed Information If you or your spouse are self-employed (e.g., files Schedule(s) C, E, F, etc.), complete this section.

Is your business a sole proprietorship?

Yes No

Name of Business

Address of Business (If other than personal residence)

Business Telephone Number

( ) -

Employer Identification Number Business Website Trade Name or DBA

Description of Business Total Number of Employees Frequency of Tax Deposits Average Gross Monthly Payroll $

Do you or your spouse have any other business interests? Include any interest in an LLC, LLP, corporation, partnership, etc.

Yes (Percentage of ownership: ) Title:

No

Business Address (Street, City, State, ZIP code)

Business Name Business Telephone Number

( ) -

Employer Identification Number

Type of business (Select one)

Partnership LLC Corporation Other

Section 5 Business Asset Information (for Self-Employed) List business assets such as bank accounts, tools, books, machinery, equipment, business vehicles and real property that is owned/leased/rented. If additional space is needed, attach a list of items.

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".

Cash Checking Savings Money Market/CD Online Account Stored Value Card

Bank Name Account Number

(8a) $

Cash Checking Savings Money Market/CD Online Account Stored Value Card

Bank Name Account Number

(8b) $

Total value of bank accounts from attachment (8c) $

Add lines (8a) through (8c) = (8) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 5 of 8 Section 5 (Continued) Business Asset Information (for Self-Employed)

Description of asset:

Current Market Value

$ X .8 = $

Less Loan Balance

– $

(if leased or used in the production of income, enter 0 as the total value) = (9a) $

Description of asset:

Current Market Value

$ X .8 = $

Less Loan Balance

– $

(if leased or used in the production of income, enter 0 as the total value) = (9b) $

Total value of assets listed from attachment [current market value X .8 less any loan balance(s)] (9c) $

Add lines (9a) through (9c) = (9) $ IRS allowed deduction for professional books and tools of trade – (10) $

Enter the value of line (9) minus line (10). If less than zero enter zero. = (11) $ Notes Receivable

Do you have notes receivable? Yes No

If yes, attach current listing which includes name and amount of note(s) receivable.

Accounts Receivable Do you have accounts receivable, including e-payment, factoring companies, and any bartering or online auction accounts? Yes No

If yes, you may be asked to provide a list of the account(s) receivable.

Do not include amount on the lines with a letter beside the number. Round to the nearest whole dollar.

Do not enter a negative number. If any line item is a negative, enter "0" on that line. Add lines (8) and (11) and enter the amount in Box B =

Box B Available Business Equity in Assets

$

Section 6 Business Income and Expense Information (for Self-Employed) Note: If you provide a current profit and loss (P&L) statement for the information below, enter the total gross monthly income on line 17 and your monthly expenses on line 29 below. Do not complete lines (12) - (16) and (18) - (28). You may use the amounts claimed for income and expenses on your most recent Schedule C; however, if the amount has changed significantly within the past year, a current P&L should be submitted to substantiate the claim.

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative number, enter "0".

Business Income (You may average 6-12 months income/receipts to determine your Gross monthly income/receipts.)

Gross receipts (12) $

Gross rental income (13) $

Interest income (14) $

Dividends (15) $

Other income (16) $

Add lines (12) through (16) = (17) $Business Expenses (You may average 6-12 months expenses to determine your average expenses.)

Materials purchased (e.g., items directly related to the production of a product or service) (18) $

Inventory purchased (e.g., goods bought for resale) (19) $

Gross wages and salaries (20) $

Rent (21) $

Supplies (items used to conduct business and used up within one year, e.g., books, office supplies, professional equipment, etc.) (22) $

Utilities/telephones (23) $

Vehicle costs (gas, oil, repairs, maintenance) (24) $

Business Insurance (25) $

Current Business Taxes (e.g., Real estate, excise, franchise, occupational, personal property, sales and employer's portion of employment taxes) (26) $Other secured debts (not credit cards) (27) $

Other business expenses (include a list) (28) $

Add lines (18) through (28) = (29) $ Round to the nearest whole dollar.

Do not enter a negative number. If any line item is a negative, enter "0" on that line. Subtract line (29) from line (17) and enter the amount in Box C =

Box C Net Business Income

$

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 6 of 8 Section 7 Monthly Household Income and Expense Information

Enter your household's gross monthly income. The information below is for yourself, your spouse, and anyone else who contributes to your household's income. The entire household includes spouse, significant other, children, and others who contribute to the household. This is necessary for the IRS to accurately evaluate your offer.

Monthly Household Income

Round to the nearest whole dollar.

Primary taxpayer

Wages

$ Social Security

+ $ Pension(s)

+ $ Other Income (e.g. unemployment)

+ $ Total primary taxpayer income = (30) $

Spouse

Wages

$ Social Security

+ $ Pension(s)

+ $ Other Income (e.g. unemployment)

+ $ Total spouse income = (31) $

Additional sources of income used to support the household, e.g., non-liable spouse, or anyone else who may contribute to the household income, etc. (32) $

Distributions (e.g., income from partnerships, sub-S Corporations, etc.) (34) $

Net rental income (35) $

Net business income from Box C (36) $

Child support received (37) $

Alimony received (38) $

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line.

Add lines (30) through (38) and enter the amount in Box D =

Box D Total Household Income

$

Monthly Household Expenses Enter your average monthly expenses.

Note: Expenses may be adjusted based on IRS Collection Financial Standards. The standards may be found at www.irs.gov.

Round to the nearest whole dollar.

Food, clothing, and miscellaneous (e.g., housekeeping supplies, personal care products , minimum payment on credit card). A reasonable estimate of these expenses may be used. (39) $

Housing and utilities (e.g., rent or mortgage payment and average monthly cost of property taxes, home insurance, maintenance, dues, fees and utilities including electricity, gas, other fuels, trash collection, water, cable television and internet, telephone, and cell phone). (40) $

Vehicle loan and/or lease payment(s) (41) $

Vehicle operating costs (e.g., average monthly cost of maintenance, repairs, insurance, fuel, registrations, licenses, inspections, parking, tolls, etc.). A reasonable estimate of these expenses may be used. (42) $

Public transportation costs (e.g., average monthly cost of fares for mass transit such as bus, train, ferry, taxi, etc.). A reasonable estimate of these expenses may be used. (43) $

Health insurance premiums (44) $

Out-of-pocket health care costs (e.g. average monthly cost of prescription drugs, medical services, and medical supplies like eyeglasses, hearing aids, etc.) (45) $

Court-ordered payments (e.g., monthly cost of any alimony, child support, etc.) (46) $

Child/dependent care payments (e.g., daycare, etc.) (47) $

Life insurance premiums (48) $

Current taxes (e.g., monthly cost of federal, state, and local tax, personal property tax, etc.) (49) $

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Interest and dividends (33) $

Page 7 of 8 Section 7 Monthly Household Income and Expense Information (Continued)

Other secured debts (e.g., any loan where you pledged an asset as collateral not previously listed, government guaranteed Student Loan) (50) $

Delinquent State and Local Taxes (51) $

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line.

Add lines (39) through (51) and enter the amount in Box E =

Box E Total Household Expenses

$

Round to the nearest whole dollar. Do not enter a negative number. If any line item is a negative, enter "0" on that line.

Subtract Box E from Box D and enter the amount in Box F =

Box F Remaining Monthly Income

$

Section 8 Calculate Your Minimum Offer Amount The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount. Paying over a shorter period of time will result in a smaller minimum offer amount.

Round to the nearest whole dollar.

If you will pay your offer in 5 months or less, multiply "Remaining Monthly Income" (Box F) by 12 to get "Future Remaining Income" (Box G). Do not enter a number less than $0.

Enter the total from Box F

$ X 12 = Box G Future Remaining Income$

If you will pay your offer in more than 5 months, multiply "Remaining Monthly Income" (Box F) by 24 to get "Future Remaining Income" (Box H). Do not enter a number less than $0.

Enter the total from Box F $ X 24 =

Box H Future Remaining Income$

Determine your minimum offer amount by adding the total available assets from Box A and Box B (if applicable) to the amount in either Box G or Box H.

Enter the amount from Box A plus Box B (if applicable)

$ +

Enter the amount from either Box G or Box H

$ =

Offer Amount Your offer must be more than zero ($0). Do not leave blank. Use whole dollars only.

$

If you cannot pay the Offer Amount shown above due to special circumstances, explain on the Form 656, Offer in Compromise, Section 3. You must offer an amount more than $0.Section 9 Other Information

Additional information IRS needs to consider settlement of your tax debt. If you or your business are currently in a bankruptcy proceeding, you are not eligible to apply for an offer.

Are you the beneficiary of a trust, estate, or life insurance policy?

Yes No

Are you currently in bankruptcy?

Yes No

Have you filed bankruptcy in the past 10 years?

Yes No

Discharge/Dismissal Date (mm/dd/yyyy) Location Filed

Are you or have you been party to a lawsuit?

Yes No

If yes, date the lawsuit was resolved: (mm/dd/yyyy)

In the past 10 years, have you transferred any assets for less than their full value?

Yes No

If yes, date the asset was transferred: (mm/dd/yyyy)

Have you lived outside the U.S. for 6 months or longer in the past 10 years?

Yes No

Do you have any funds being held in trust by a third party?

Yes No If yes, how much $ Where:

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Page 8 of 8 Section 10 Signatures

Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it is true, correct, and complete.

► Signature of Taxpayer Date (mm/dd/yyyy)

► Signature of Taxpayer Date (mm/dd/yyyy)

Remember to include all applicable attachments listed below.

Copies of the most recent pay stub, earnings statement, etc., from each employer

Copies of the most recent statement for each investment and retirement account

Copies of the most recent statement, etc., from all other sources of income such as pensions, Social Security, rental income, interest and dividends (including any received from a related partnership, corporation, LLC, LLP, etc.), court order for child support, alimony, and rent subsidies

Copies of bank statements for the three most recent months

Copies of the most recent statement from lender(s) on loans such as mortgages, second mortgages, vehicles, etc., showing monthly payments, loan payoffs, and balances

List of Notes Receivable, if applicable

Verification of State/Local Tax Liability, if applicable

Documentation to support any special circumstances described in the “Explanation of Circumstances” on Form 656, if applicable

Attach a Form 2848, Power of Attorney, if you would like your attorney, CPA, or enrolled agent to represent you and you do not have a current form on file with the IRS.

Catalog Number 55896Q www.irs.gov Form 433-A (OIC) (Rev. 1-2015)

Form 656 (Rev. January 2015) Offer in Compromise

Department of the Treasury — Internal Revenue Service

Did you use the Pre-Qualifier tool located on our website at www.irs.gov prior to filling out this form?Yes No

Include the Application Fee and Payment (personal check, cashier's check, or money order) with your Form 656. You must also include the completed Form 433-A (OIC) and/or 433-B (OIC) and supporting documentation.

Section 1 Your Information Section 1A Individual Information (Form 1040 Filers)

Your First Name, Middle Initial, Last Name Social Security Number (SSN)

- -If a Joint Offer, Spouse's First Name, Middle Initial, Last Name Social Security Number (SSN)

- -Your Physical Home Address (Street, City, State, ZIP Code)

Mailing Address (if different from above or Post Office Box number)

Employer Identification Number (For self-employed individuals only)

-

IRS Received Date

Section 1B Business Information (Form 1120, 1065, etc., filers)If your business is a Corporation, Partnership, LLC, or LLP and you want to compromise those tax debts, you must complete this section. You must also include all required documentation including the Form 433-B (OIC), $186 application fee, and initial payment.Business Name

Business Address (Street, City, State, ZIP Code)

Employer Identification Number (EIN)

-

Name and Title of Primary Contact Telephone Number

( ) -

► To: Commissioner of Internal Revenue Service

In the following agreement, the pronoun "we" may be assumed in place of "I" when there are joint liabilities and both parties are signing this agreement. I submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts required by law for the tax type and period(s) marked below:

Section 2 Tax Periods Section 2A If Your Offer is for Individual Tax Debt Only

Complete this Section only if you completed Section 1A1040 Income Tax-Year(s)

Trust Fund Recovery Penalty as a responsible person of (enter corporation name)

for failure to pay withholding and Federal Insurance Contributions Act taxes (Social Security taxes), for period(s) ending

941 Employer's Quarterly Federal Tax Return - Quarterly period(s)

940 Employer's Annual Federal Unemployment (FUTA) Tax Return - Year(s)

Other Federal Tax(es) [specify type(s) and period(s)]

Note: If you need more space, use attachment and title it “Attachment to Form 656 dated .” Make sure to sign and date the attachment.

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

Page 2 of 6

Section 2 (continued) Tax Periods Section 2B If Your Offer is for Business Tax Debt

Complete this Section only if you completed Section 1B1120 Income Tax-Year(s)

941 Employer's Quarterly Federal Tax Return - Quarterly period(s)

940 Employer's Annual Federal Unemployment (FUTA) Tax Return - Year(s)

Other Federal Tax(es) [specify type(s) and period(s)]

Note: If you need more space, use attachment and title it “Attachment to Form 656 dated .” Make sure to sign and date the attachment.

Section 3 Reason for Offer

Doubt as to Collectibility - I have insufficient assets and income to pay the full amount.

Exceptional Circumstances (Effective Tax Administration) - I owe this amount and have sufficient assets to pay the full amount, but due to my exceptional circumstances, requiring full payment would cause an economic hardship or would be unfair and inequitable. I am submitting a written narrative explaining my circumstances.

Explanation of Circumstances (Add additional pages, if needed) – The IRS understands that there are unplanned events or special circumstances, such as serious illness, where paying the full amount or the minimum offer amount might impair your ability to provide for yourself and your family. If this is the case and you can provide documentation to prove your situation, then your offer may be accepted despite your financial profile. Describe your situation below and attach appropriate documents to this offer application.

Section 4 Low-Income Certification (Individuals and Sole Proprietors Only)

Do you qualify for Low-Income Certification? You qualify if your gross monthly household income is less than or equal to the amount shown in the chart below based on your family size and where you live. If you qualify, you are not required to submit any payments during the consideration of your offer. Businesses other than sole proprietorships do not qualify for the low income waiver.

Check here if you qualify for Low Income Certification based on the monthly income guidelines below.

Size of family unit 48 contiguous states and D.C. Hawaii Alaska

1 $2,431 $2,796 $3,038

2 $3,277 $3,769 $4,096

3 $4,123 $4,742 $5,154

4 $4,969 $5,715 $6,213

5 $5,815 $6,688 $7,271

6 $6,660 $7,660 $8,329

7 $7,506 $8,633 $9,388

8 $8,352 $9,606 $10,446

For each additional person, add $ 846 $ 973 $1,058

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

Page 3 of 6

Section 5 Payment Terms Check one of the payment options below to indicate how long it will take you to pay your offer in full. You must

offer more than $0. The offer amount should be in whole dollars only.▼ ▼Lump Sum Cash

Check here if you will pay your offer in 5 or fewer payments in 5 or fewer months from the date of acceptance: Enclose a check for 20% of the offer amount (waived if you are an individual or sole proprietorship and met the requirements for Low Income Certification) and fill in the amount(s) of your future payment(s).

Total Offer Amount - 20% Initial Payment = Remaining Balance

$ - $ = $ You may pay the remaining balance in one payment after acceptance of the offer or up to five payments, but cannot exceed 5 months.

Amount of payment $ payable within Month after acceptance

Amount of payment $ payable within Months after acceptance

Amount of payment $ payable within Months after acceptance

Amount of payment $ payable within Months after acceptance

Amount of payment $ payable within Months after acceptance

Periodic Payment

Enter the amount of your offer $

Check here if you will pay your offer in full in 6 to 24 months.

Note: The total amount must equal all of the proposed payments including the first and last payments.

$ is included with this offer then $ will be sent in on the day of each month thereafter

for a total of

Note: The total months may not exceed a total of 24 months, including the first payment. Your first payment is considered to be month 1; therefore, the remainder of the payments must be made within 23 months for a total of 24.

You must continue to make these monthly payments while the IRS is considering the offer (waived if you are an individual or sole proprietorship and met the requirements for Low Income Certification). Failure to make regular monthly payments will cause your offer to be returned with no appeal rights.

IRS Use Only

Attached is an addendum dated (insert date) setting forth the amended offer amount and payment terms.

months with a final payment of $ to be paid on the day of the month.

Enclose a check for the first month's installment.

Section 6 Designation of Down Payment and Deposit

If you want your payment to be applied to a specific tax year and a specific tax debt, please tell us the tax form and

tax year/quarter . If you do not designate a preference, we will apply any money you send to the government's best interest. If you wishto designate any payments not included with this offer, you must designate a preference for each payment at the time the payment is made. However, you cannot designate the $186 application fee or any payment after the IRS accepts the offer.

If you are paying more than the required payment when you submit your offer and want any part of that payment treated as a deposit, check the box below and insert the amount. Deposits will be refunded if the offer is rejected, returned, or withdrawn, unless you request it to be applied to your tax debt.

My payment of $ includes the $186 application fee and $ for my initial offer payment. I am requesting the

additional payment of $ be held as a deposit.

CAUTION: Do NOT designate the amounts sent in with your offer to cover the down payment and application fee as “deposits.” Doing so will result in the return of your offer.

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

Page 4 of 6

Section 7 Source of Funds, Making Your Payment, and Filing RequirementsSource of FundsTell us where you will obtain the funds to pay your offer. You may consider borrowing from friends and/or family, taking out a loan, or selling assets.

Making Your PaymentInclude separate checks for the payment and application fee. Make checks payable to the “United States Treasury” and attach to the front of your Form 656, Offer in Compromise. All payments must be in U.S. dollars. Do not send cash. Send a separate application fee with each offer; do not combine it with any other tax payments, as this may delay processing of your offer. Your offer will be returned to you if the application fee and the required payment is not included, or if your check is returned for insufficient funds.

Filing Requirements

I certify that I have filed all required tax returns.

I certify that I was not required to file a tax return for the following years:

Section 8 Offer Terms By submitting this offer, I/we have read, understand and agree to the following terms and conditions:

Terms, Conditions, and Legal Agreement

a) I request that the IRS accept the offer amount listed in this offer application as payment of my outstanding tax debt (including interest, penalties, and any additional amounts required by law) as of the date listed on this form. I authorize the IRS to amend Section 2 on page 1 in the event I failed to list any of my assessed tax debt, or tax debt assessed before acceptance of my offer. I also authorize the IRS to amend Section 2 on page 1 by removing any tax years on which there is currently no outstanding liability. I understand that my offer will be accepted, by law, unless IRS notifies me otherwise, in writing, within 24 months of the date my offer was received by IRS. I also understand that if any tax debt that is included in the offer is in dispute in any judicial proceeding it/they will not be included in determining the expiration of the 24-month period.

IRS will keep my payments, fees, and some refunds.

b) I voluntarily submit the payments made on this offer and understand that they are not refundable even if I withdraw the offer or the IRS rejects or returns the offer. Unless I designate how to apply each required payment in Section 6 page 3, the IRS will apply my payment in the best interest of the government, choosing which tax years and tax debts to pay off. The IRS will also keep my application fee unless the offer is not accepted for processing.

c) The IRS will keep any refund, including interest, that I might be due for tax periods extending through the calendar year in which the IRS accepts my offer. I cannot designate that the refund be applied to estimated tax payments for the following year or the accepted offer amount. If I receive a refund after I submit this offer for any tax period extending through the calendar year in which the IRS accepts my offer, I will return the refund within 30 days of notification.

I understand that the amount I am offering may not include part or all of an expected or current tax refund, money already paid, funds attached by any collection action, or anticipated benefits from a capital or net operating loss.

d) The IRS will keep any monies it has collected prior to this offer. The IRS may levy my assets up to the time that the IRS official signs and acknowledges my offer as pending, which is accepted for processing and the IRS may keep any proceeds arising from such a levy. No levy will be issued on individual shared responsibility payments.

The IRS will keep any payments that I make related to this offer. I agree that any funds submitted with this offer will be treated as a payment unless I checked the box to treat an overpayment as a deposit. Only amounts that exceed the mandatory payments can be treated as a deposit. I also agree that any funds submitted with periodic payments made after the submission of this offer and prior to the acceptance, rejection, or return of this offer will be treated as payments, unless I identify an overpayment as a deposit on the check submitted with the corresponding periodic payment. A deposit will be refundable if the offer is rejected, returned, or withdrawn. I understand that the IRS will not pay interest on any deposit.

Pending status of an offer and right to appeal

e) Once an authorized IRS official signs this form, my offer is considered pending as of that signature date and it remains pending until the IRS accepts, rejects, returns, or I withdraw my offer. An offer is also considered pending 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. An offer will be considered withdrawn when the IRS receives my written notification of withdrawal by personal delivery or certified mail or when I inform the IRS of my withdrawal by other means and the IRS acknowledges in writing my intent to withdraw the offer.

f) I waive the right to an Appeals hearing if I do not request a hearing in writing within 30 days of the date the IRS notifies me of the decision to reject the offer.

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

Page 5 of 6 Section 8 (Continued) Offer Terms

I must comply with my future tax obligations and understand I remain liable for the full amount of my tax debt until all terms and conditions of this offer have been met.

g) I will comply with all provisions of the internal revenue laws, including requirements to timely file tax returns and timely pay taxes for the five year period beginning with the date of acceptance of this offer and ending through the fifth year, including any extensions to file and pay. I also agree to promptly pay any liabilities assessed after acceptance of this offer for tax years ending prior to acceptance of this offer that were not otherwise identified in Section 2 of this agreement. If this is an offer being submitted for joint tax debt, and one of us does not comply with future obligations, only the non-compliant taxpayer will be in default of this agreement. An accepted offer will not be defaulted solely due to the assessment of an individual shared responsibility payment.

h) I agree that I will remain liable for the full amount of the tax liability, accrued penalties and interest, until I have met all of the terms and conditions of this offer. Penalty and interest will continue to accrue until all payment terms of the offer have been met. If I file for bankruptcy before the terms and conditions of the offer are met, I agree that the IRS may file a claim for the full amount of the tax liability, accrued penalties and interest, and that any claim the IRS files in the bankruptcy proceeding will be a tax claim.

i) Once the IRS accepts my offer in writing, I have no right to challenge the tax debt(s) in court or by filing a refund claim or refund suit for any liability or period listed in Section 2, even if I default the terms of the accepted offer.

I understand what will happen if I fail to meet the terms of my offer (e.g., default).

j) If I fail to meet any of the terms of this offer, the IRS may levy or sue me to collect any amount ranging from the unpaid balance of the offer to the original amount of the tax debt (less payments made) plus penalties and interest that have accrued from the time the underlying tax liability arose. The IRS will continue to add interest, as Section 6601 of the Internal Revenue Code requires, on the amount the IRS determines is due after default.

I agree to waive time limits provided by law.

k) To have my offer considered, I agree to the extension of the time limit provided by law to assess my tax debt (statutory period of assessment). I agree that the date by which the IRS must assess my tax debt will now be the date by which my debt must currently be assessed plus the period of time my offer is pending plus one additional year if the IRS rejects, returns, or terminates my offer or I withdraw it. (Paragraph (e) of this section 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 a Notice of Federal Tax Lien on my property.

l) The IRS may file a Notice of Federal Tax Lien during the offer investigation. The IRS may file a Notice of Federal Tax Lien to protect the Government’s interest on offers that will be paid over time. This tax lien will be released when the payment terms of the accepted offer have been satisfied. The IRS will not file a Notice of Federal Tax Lien on any individual shared responsibility debt.

Correction Agreement m) I/We authorize IRS, to correct any typographical or clerical errors or make minor modifications to my/our Form 656 that I/We signed in connection to this offer.

I authorize the IRS to contact relevant third parties in order to process my offer

n) By authorizing the IRS to contact third parties, I understand that I will not be notified of which third parties the IRS contacts as part of the offer application process, including tax periods that have not been assessed, as stated in section 7602 (c ) of the Internal Revenue Code. In addition, I authorize the IRS to request a consumer report on me from a credit bureau.

I am submitting an offer as an individual for a joint liability

o) I understand if the liability sought to be compromised is the joint and individual liability of myself and my co-obligor(s) and I am submitting this offer to compromise my individual liability only, then if this offer is accepted, 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).

Shared Responsibility Payment (SRP)

p) If your offer includes any shared responsibility payment (SRP) amount that you owe for not having minimum essential health coverage for you and, if applicable, your dependents per Internal Revenue Code Section 5000A – Individual shared responsibility payment, it is not subject to penalties or to lien and levy enforcement actions. However, interest will continue to accrue until you pay the total SRP balance due. We may apply your federal tax refunds to the SRP amount that you owe until it is paid in full.

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.

►Signature of Taxpayer/Corporation Name Phone Number Date (mm/dd/yyyy)

►Signature of Taxpayer/Authorized Corporate Officer Phone Number Date (mm/dd/yyyy)

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

Page 6 of 6

Section 10 Paid Preparer Use Only Signature of Preparer Phone Number Date (mm/dd/yyyy)

Name of Paid Preparer Preparer's CAF no. or PTIN

Firm's Name (or yours if self-employed), Address, and ZIP Code

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

Section 11 Third Party Designee

Do you want to allow another person to discuss this offer with the IRS? Yes No

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.

Catalog Number 16728N www.irs.gov Form 656 (Rev. 1-2015)

APPLICATION CHECKLIST Review the entire application using the Application Checklist below. Include this checklist with your application.

Forms 433-A (OIC), 433-B (OIC), and 656

Did you complete all fields and sign all forms?

Did you make an offer amount that is equal to the offer amount calculated on the Form 433-A (OIC) or Form 433-B (OIC)? If not, did you describe the special circumstances that are leading you to offer less than the minimum in the “Explanation of Circumstances” Section 3 of Form 656, and did you provide supporting documentation of the special circumstances?

Did you select a payment option on Form 656?

If you want to allow the IRS to discuss your offer with another person, did you complete the “Third-Party Designee” section on the Form 656?

If someone other than you completed the Form 656, did they sign it?

Did you sign and attach the Form 433-A (OIC) if applicable?

Did you sign and attach the Form 433-B (OIC) if applicable?

Did you sign and attach the Form 656?

If you are making an offer that includes business and individual tax debts, did you prepare a separate Form 656 package (including separate financial statements, supporting documentation, application fee, and initial payment)?

Supporting documentation and additional forms

Did you include photocopies of all required supporting documentation?

If you want a third party to represent you during the offer process, did you include a Form 2848 or Form 8821 unless one is already on file?

Payment Did you include a check or money order made payable to the “United States Treasury” for the initial payment? (Waived if you meet Low Income Certification guidelines—see Form 656.)

Did you include a separate check or money order made payable to the “United States Treasury” for the $186 application fee? (Waived if you meet Low Income Certification guidelines—see Form 656.)

Mail your application package to the appropriate IRS facility

Mail the Form 656, 433-A (OIC) and/or 433-B (OIC), and related financial document(s) to the appropriate IRS processing office for your state. You may wish to send it by Certified Mail so you have a record of the date it was mailed.

If you reside in: Mail your application to:

AK, AL, AR, AZ, CO, FL, GA, HI, ID, KY, LA, MS, MT, NC, NM, NV, OK, OR, SC, TN, TX, UT, WA, WI, WY

Memphis IRS Center COIC Unit P.O. Box 30803, AMC Memphis, TN 38130-0803 1-866-790-7117

CA, CT, DE, IA, IL, IN, KS, MA, MD, ME, MI, MN, MO, ND, NE, NH, NJ, NY, OH, PA, RI, SD, VT, VA, WV; DC, PR, or a foreign address

Brookhaven IRS Center COIC Unit P.O. Box 9007 Holtsville, NY 11742-9007 1-866-611-6191

27

Catalog Number 22710P www.irs.gov Form 4180 (Rev. 8-2012)

Form 4180(August 2012)

Department of the Treasury - Internal Revenue Service

Report of Interview with Individual Relative to Trust Fund Recovery Penalty or Personal Liability for Excise Taxes

Instructions: The interviewer must prepare this form either in person or via telephone.Do not leave any information blank. Enter ''N/A'' if an item is not applicable.

Section I - Person Interviewed1. Name 2. Social Security Number (SSN)

3. Address (street, city, state, ZIP code) 4. Home telephone number

( )

5. Work telephone number

( )

6. Name of Business and Employer Identification Number (EIN) 7. Did you use a third-party payer, such as a payroll service?

Yes (If yes complete Section VI A)

No

8. What was your job title and how were you associated with the business? (Describe your duties and responsibilities and dates of employment.) If person being interviewed is a payroll service provider or a professional employer organization, complete Section VI B

Section II - Responsibilities1. State whether you performed any of the duties / functions listed below for the business and the time periods during which you

performed these duties.

Did you... Yes No DatesFrom To

a. Determine financial policy for the business?b. Direct or authorize payments of bills/creditors?c. Prepare, review, sign, or authorize transmit payroll tax returns?d. Have knowledge withheld taxes were not paid?e. Authorize payroll?f. Authorize or make Federal Tax Deposits?g. Authorize the assignment of any EFTPS or electronic banking PINS/passwords?h. Could other individuals do any of the above? (Complete Section IV and V)

Name Contact Number

i. Have signature authority or PIN assignment on business bank accounts?Bank Name(s) Account Number(s)

Section III - SignaturesI declare that I have examined the information given in this interview and to the best of my knowledge and belief, it is true, correct, and complete.

Signature of person interviewed Date

Signature of Interviewer Date

Date copy of completed interview form given to person interviewed

Taxpayer Statement on Page 4: Yes No Interview Continued on subsequent pages? Yes No

Interview Handouts (''X'' if given or explain why not in case history.)

Notice 609, Privacy Act Notice Notice 784, Could You be Personally Liable for Certain Unpaid Federal Taxes?

Page 2

Catalog Number 22710P www.irs.gov Form 4180 (Rev. 8-2012)

Section IV - Business Information1. List corporate positions below, identifying the persons who occupied them and their dates of service.

Position (e.g. president, director) Name Address Dates

2. Did/does the business use the Electronic Federal Tax Payment System (EFTPS) to make Federal Tax Deposits (FTD's) or payments?

NoYes If yes, to whom are the PINS or passwords assigned

3. Other than the EFTPS, does the business do any other banking electronically?

NoYes Where

To whom are the PINs/passwords assigned

4. Does the business file Form 941 electronically?NoYes

Who is authorized to sign Form 941Who files the returns electronically

Section V - Knowledge / Willfulness1. During the time the delinquent taxes were increasing, or at any time thereafter, were any financial obligations of the business paid?

(such as rent, mortgage, utilities, vehicle or equipment loans, or payments to vendors)

NoYes Which obligations were paid?

Who authorized them to be paid?

2. Were all or a portion of the payrolls met?NoYes

Who authorized

3. Did any person or organization provide funds to pay net corporate payroll?NoYes (explain in detail and provide name)

4. When and how did you first become aware of the unpaid taxes? 5. What actions did you attempt to see that the taxes were paid?

6. Were discussions ever held by stockholders, officers, or other interested parties regarding nonpayment of the taxes?

NoYes

Identify who attended, dates, any decisions reached, and whether any documentation is available.

7. Who handled IRS contacts such as phone calls, correspondence, or visits by IRS personnel?

When did these contacts take place, and what were the results of these contacts?

Page 3

Catalog Number 22710P www.irs.gov Form 4180 (Rev. 8-2012)

Section VI - Payroll Service Provider (PSP) or Professional Employer Organization (PEO)A - Third-Party Payer Arrangements(complete this section only if you are interviewing a taxpayer who used a third-party payer)

1. Who signed the service contract or entered into the agreement for services with the third-party payer?

2. Who in the business handled the contacts with the third-party payer?

3. Who was your contact at the third-party payer? 4. How were funds to be made available for the third-party payer to pay the taxes?

Name of Bank(s) and Account number(s) from which funds were to be transferred.

5. What actions did you take to verify the third-party payer was filing returns, or making required payments?

6. Were funds available for the third-party payer to use for payment of the taxes?

Yes NoIf yes, explain in detail how and when the money was transferred to the third-party.

7. Were you aware that the third-party payer was not making the required payments?

Yes No

8. Did you receive IRS notices indicating that the employment tax returns were not filed, or that the employment taxes were not paid?

Yes NoB - Third-Party Payer Companies (complete this section only if you are interviewing a Third-Party Payroll Service Payer)

1. Who in your organization handled the contacts with the client? 2. Who was your contact at the client business?

3. Who at the client business signed the service contract or entered into the agreement for services?

4. Who had control over the payments of the client's employment taxes?

5. How were funds to be made available from the client business to pay the taxes?

Bank Name(s) Account Number(s)

6. Were there funds actually available for you to make the tax payments?Yes No

If yes, explain in detail how and when the money was transferred to the third-party.

If no, what actions did you take to attempt to collect the funds from the client?

Section VII - Personal Liability for Excise Tax Cases(Complete only if Business is required to file Excise Tax Returns)

1. Are you aware of any required excise tax returns which have not been filed?

No Yes (list periods)

2. With respect to excise taxes, were the patrons or customers informed that the tax was included in the sales price?

No Yes

3. If the liability is one of the ''collected'' taxes (transportation ofpersons or property and communications), was the tax collected?

No Yes

4. Were you aware, during the period tax accrued, that the law required collection of the tax?

No Yes

Page 4

Catalog Number 22710P www.irs.gov Form 4180 (Rev. 8-2012)

Additional Information

Interview Handouts (''X'' if given or explain why not in case history.)

Notice 609, Privacy Act Notice Notice 784, Could You be Personally Liable for Certain Unpaid Federal Taxes?

Section VIII - SignaturesI declare that I have examined the information given in this interview and to the best of my knowledge and belief, it is true, correct, and complete.

Signature of person interviewed Date

Signature of Interviewer Date

Date copy of completed interview form given to person interviewed

Form 9423 (Rev. 8-2014) Catalog Number 14169I Department of the Treasury - Internal Revenue Servicewww.irs.gov

1. Taxpayer’s name 2. Representative (Attach a copy of Form 2848, Power of Attorney)

3. SSN/EIN 4. Taxpayer’s business phone 5. Taxpayer’s home phone 6. Representative’s phone

7. Taxpayer’s street address

8. City 9. State 10. ZIP code

11. Type of tax (Tax form) 12. Tax periods being appealed 13. Tax due

Collection Action(s) Appealed14. Check the Collection action(s) you are appealing

Federal Tax Lien Levy or Proposed Levy Seizure

Rejection of Installment Agreement Termination of Installment Agreement Modification of Installment Agreement

Explanation15. Explain why you disagree with the collection action(s) you checked above and explain how you would resolve your tax problem.

Attach additional pages if needed. Attach copies of any documents that you think will support your position. Generally, the Office of Appeals will ask the Collection Function to review, verify and provide their opinion on any new information you submit. We will share their comments with you and give you the opportunity to respond.

Under penalties of perjury, I declare that I have examined this request and any accompanying documents, and to the best of my knowledge and belief, they are true, correct and complete. A submission by a representative, other than the taxpayer, is based on all information of which the representative has any knowledge.

16. Taxpayer’s or Authorized Representative’s signature (Only check one box) 17. Date signed

IRS USE ONLY18. Revenue Officer's name 19. Revenue Officer's signature 20. Date signed

21. Revenue Officer's phone 22. Revenue Officer's email address 23. Date received

24. Collection Manager’s name 25. Collection Manager’s signature 26. Date signed

27. Collection Manager’s phone 28. Collection Manager’s email address 29. Date received

Form 9423 (August 2014)

Department of the Treasury - Internal Revenue Service

Collection Appeal Request (Instructions are on the reverse side of this form)

Form 9423 (Rev. 8-2014) Catalog Number 14169I Department of the Treasury - Internal Revenue Servicewww.irs.gov

Instructions for Form 9423, Collection Appeal RequestFor Liens, Levies, Seizures, and Rejection, Modification or Termination of Installment Agreements A taxpayer, or third party whose property is subject to a collection action, may appeal the following actions under the Collection Appeals

Program (CAP): a. Levy or seizure action that has been or will be taken. b. A Notice of Federal Tax Lien (NFTL) that has been or will be filed. c. The filing of a notice of lien against an alter-ego or nominee's property. d. Denials of requests to issue lien certificates, such as subordination, withdrawal, discharge or non-attachment. e. Rejected, proposed for modification or modified, or proposed for termination or terminated installment agreements. f. Disallowance of taxpayer's request to return levied property under IRC 6343(d). g. Disallowance of property owner's claim for return of property under IRC 6343(b).

How to Appeal If You Disagree With a Lien, Levy, or Seizure Action 1. If you disagree with the decision of the IRS employee, and wish to appeal, you must first request a conference with the employee's

manager. If you do not resolve your disagreement with the Collection manager, submit Form 9423 to request consideration by Appeals. Let the Collection office know within two (2) business days after the conference with the Collection manager that you plan to submit Form 9423. The Form 9423 must be received or postmarked within three (3) business days of the conference with the Collection manager or collection action may resume. NOTE: If you request an appeal after IRS makes a seizure, you must appeal to the Collection manager within 10 business days after the Notice of Seizure is provided to you or left at your home or business.

2. If you request a conference and are not contacted by a manager or his/her designee within two (2) business days of making the

request, you can contact Collection again or submit Form 9423. If you submit Form 9423, note the date of your request for a conference in Block 15 and indicate that you were not contacted by a manager. The Form 9423 should be received or postmarked within four (4) business days of your request for a conference as collection action may resume.

3. On the Form 9423, check the collection action(s) you disagree with and explain why you disagree. You must also explain your

solution to resolve your tax problem. Submit Form 9423 to the Collection office involved in the lien, levy or seizure action. 4. In situations where the IRS action(s) are creating an economic harm or you want help because your tax problem has not been

resolved through normal channels, you can reach the Taxpayer Advocate Service at 877-777-4778. How to Appeal An Installment Agreement Which Has Been Rejected, Proposed for Modification or Modified, or Proposed for Termination or Terminated 1. If you disagree with the decision regarding your installment agreement, you should appeal by completing a Form 9423, Collection

Appeal Request. 2. You should provide it to the office or revenue officer who took the action regarding your installment agreement, within 30 calendar

days. NOTE: A managerial conference is not required. However, it is strongly recommended a conference be held with the manager whenever possible. IMPORTANT: Never forward your request for an Appeals conference directly to Appeals. It must be submitted to the office which took the action on your installment agreement.

What Will Happen When You Appeal Your Case Normally, we will stop the collection action(s) you disagree with until your appeal is settled, unless we have reason to believe that collection or the amount owed is at risk. You May Have a Representative You may represent yourself at your Appeals conference or you may be represented by an attorney, certified public accountant or a person enrolled to practice before the IRS. If you want your representative to appear without you, you must provide a properly completed Form 2848, Power of Attorney and Declaration of Representative. You can obtain Form 2848 from your local IRS office, by calling 1-800-829-3676, or by going to www.irs.gov. Decision on the Appeal Once Appeals makes a decision regarding your case, that decision is binding on both you and the IRS. You cannot obtain a judicial review of Appeals' decision following a CAP. However, there may be other opportunities to obtain administrative or judicial review of the issue raised in the CAP hearing. For example, a third party may contest a wrongful levy by filing an action in district court. See Publication 4528, Making an Administrative Wrongful Levy Claim Under Internal Revenue Code (IRC) Section 6343(b).   

Note: Providing false information, failing to provide all pertinent information or fraud will void Appeals' decision. Refer to Publication 594, The IRS Collection Process, and Publication 1660, Collection Appeal Rights, for more information regarding the Collection Appeals Program. Copies of these publications can be obtained online at www.irs.gov.

The information requested on this Form is covered under Privacy Acts and Paperwork Reduction Notices which have already been provided to the taxpayer.

Privacy Act

Form 12153 (Rev. 12-2013)

Request for a Collection Due Process or Equivalent Hearing

Form 12153 (Rev. 12-2013) Catalog Number 26685D www.irs.gov Department of the Treasury - Internal Revenue Service

Use this form to request a Collection Due Process (CDP) or equivalent hearing with the IRS Office of Appeals if you have been issued one of the following lien or levy notices:

• Notice of Federal Tax Lien Filing and Your Right to a Hearing under IRC 6320, • Notice of Intent to Levy and Notice of Your Right to a Hearing, • Notice of Jeopardy Levy and Right of Appeal, • Notice of Levy on Your State Tax Refund, • Notice of Levy and Notice of Your Right to a Hearing.

Complete this form and send it to the address shown on your lien or levy notice. Include a copy of your lien or levy notice to ensure proper handling of your request.

Call the phone number on the notice or 1-800-829-1040 if you are not sure about the correct address or if you want to fax your request.

You can find a section explaining the deadline for requesting a Collection Due Process hearing in this form's instructions. If you've missed the deadline for requesting a CDP hearing, you must check line 7 (Equivalent Hearing) to request an equivalent hearing.

1. Taxpayer Name: (Taxpayer 1)

Taxpayer Identification Number

Current Address

City State Zip Code2. Telephone Number and Best Time

to Call During Normal Business Hours

Home ( ) - am. pm.Work ( ) - am. pm.

Cell ( ) - am. pm.

3. Taxpayer Name: (Taxpayer 2)

Taxpayer Identification Number

Current Address(If Different from Address Above) City State Zip Code

4. Telephone Number and Best Time to Call During Normal Business Hours

Home ( ) - am. pm.Work ( ) - am. pm.

Cell ( ) - am. pm.

5. Tax Information as Shown on the Lien or Levy Notice (If possible, attach a copy of the notice)Type of Tax (Income, Employment, Excise, etc. or Civil Penalty)

Tax Form Number (1040, 941, 720, etc) Tax Period or Periods

Form 12153 (Rev. 12-2013)

Request for a Collection Due Process or Equivalent Hearing

Form 12153 (Rev. 12-2013) Catalog Number 26685D www.irs.gov Department of the Treasury - Internal Revenue Service

6. Basis for Hearing Request (Both boxes can be checked if you have received both a lien and levy notice)

Filed Notice of Federal Tax Lien Proposed Levy or Actual Levy

7. Equivalent Hearing (See the instructions for more information on Equivalent Hearings)

I would like an Equivalent Hearing - I would like a hearing equivalent to a CDP Hearing if my request for a CDP hearing does not meet the requirements for a timely CDP Hearing.

8. Check the most appropriate box for the reason you disagree with the filing of the lien or the levy. See page 4 of this form for examples. You can add more pages if you don't have enough space.

If, during your CDP Hearing, you think you would like to discuss a Collection Alternative to the action proposed by the Collection function it is recommended you submit a completed Form 433A (Individual) and/or Form 433B (Business), as appropriate, with this form. See www.irs.gov for copies of the forms. Generally, the Office of Appeals will ask the Collection Function to review, verify and provide their opinion on any new information you submit. We will share their comments with you and give you the opportunity to respond.

Collection Alternative Installment Agreement Offer in Compromise I Cannot Pay Balance

Lien Subordination WithdrawalDischargePlease explain:

My Spouse Is Responsible Innocent Spouse Relief (Please attach Form 8857, Request for Innocent Spouse Relief, to your request.)

Other (For examples, see page 4)Reason (You must provide a reason for the dispute or your request for a CDP hearing will not be honored. Use as much space as you need to explain the reason for your request. Attach extra pages if necessary.):

9. Signatures I understand the CDP hearing and any subsequent judicial review will suspend the statutory period of limitations for collection action. I also understand my representative or I must sign and date this request before the IRS Office of Appeals can accept it. If you are signing as an officer of a company add your title (president, secretary, etc.) behind your signature.

SIGN HERE Taxpayer 1's Signature Date

Taxpayer 2's Signature (if a joint request, both must sign) Date

I request my CDP hearing be held with my authorized representative (attach a copy of Form 2848)

Authorized Representative's Signature Authorized Representative's Name Telephone Number

IRS Use OnlyIRS Employee (Print) Employee Telephone Number IRS Received Date

Information You Need To Know When Requesting A Collection Due Process Hearing

Form 12153 (Rev. 12-2013) Catalog Number 26685D www.irs.gov Department of the Treasury - Internal Revenue Service

What Is the Deadline for Requesting a Timely Collection Due Process (CDP) Hearing? • Your request for a CDP hearing about a Federal Tax Lien filing must be postmarked by the date indicated in

the Notice of Federal Tax Lien Filing and Your Right to a Hearing under IRC 6320 (lien notice). • Your request for a CDP hearing about a levy must be postmarked within 30 days after the date of the Notice of

Intent to Levy and Notice of Your Right to a Hearing (levy notice) or Notice of Your Right to a Hearing After an Actual Levy.

Your timely request for a CDP hearing will prohibit levy action in most cases. A timely request for CDP hearing will also suspend the 10-year period we have, by law, to collect your taxes. Both the prohibition on levy and the suspension of the 10-year period will last until the determination the IRS Office of Appeals makes about your disagreement is final. The amount of time the suspension is in effect will be added to the time remaining in the 10-year period. For example, if the 10-year period is suspended for six months, the time left in the period we have to collect taxes will be extended by six months. You can go to court to appeal the CDP determination the IRS Office of Appeals makes about your disagreement.

What Is an Equivalent Hearing? If you still want a hearing with the IRS Office of Appeals after the deadline for requesting a timely CDP hearing has passed, you can use this form to request an equivalent hearing. You must check the Equivalent Hearing box on line 7 of the form to request an equivalent hearing. An equivalent hearing request does not prohibit levy or suspend the 10-year period for collecting your taxes; also, you cannot go to court to appeal the IRS Office of Appeals' decision about your disagreement. You must request an equivalent hearing within the following timeframe:

• Lien Notice—one year plus five business days from the filing date of the Notice of Federal Tax Lien. • Levy Notice—one year from the date of the levy notice. • Your request for a CDP levy hearing, whether timely or Equivalent, does not prohibit the Service from filing a

Notice of Federal Tax Lien.

Where Should You File Your CDP or Equivalent Hearing Request? File your request by mail at the address on your lien notice or levy notice. You may also fax your request. Call the telephone number on the lien or levy notice to ask for the fax number. Do not send your CDP or equivalent hearing request directly to the IRS Office of Appeals, it must be sent to the address on the lien or levy notice. If you send your request directly to Appeals it may result in your request not being considered a timely request. Depending upon your issue the originating function may contact you in an attempt to resolve the issue(s) raised in your request prior to forwarding your request to Appeals.

Where Can You Get Help? You can call the telephone number on the lien or levy notice with your questions about requesting a hearing. The contact person listed on the notice or other representative can access your tax information and answer your questions. In addition, you may qualify for representation by a low-income taxpayer clinic for free or nominal charge. Our Publication 4134, Low Income Taxpayer Clinic List, provides information on clinics in your area. If you are experiencing economic harm, the Taxpayer Advocate Service (TAS) may be able to help you resolve your problems with the IRS. TAS cannot extend the time you have to request a CDP or equivalent hearing. See Publication 594, The IRS Collection Process, or visit www.irs.gov/advocate/index-html. You also can call 1-877-777-4778 for TAS assistance. Note–The IRS Office of Appeals will not consider frivolous requests. You can find examples of frivolous reasons for requesting a hearing or disagreeing with a tax assessment in Publication 2105, Why do I have to Pay Taxes?, or at www.irs.gov by typing “frivolous” into the search engine.

You can get copies of tax forms, schedules, instructions, publications, and notices at www.irs.gov, at your local IRS office, or by calling toll-free 1-800-TAX-FORM (829-3676).

Information You Need To Know When Requesting A Collection Due Process Hearing

Form 12153 (Rev. 12-2013) Catalog Number 26685D www.irs.gov Department of the Treasury - Internal Revenue Service

What Are Examples of Reasons for Requesting a Hearing? You will have to explain your reason for requesting a hearing when you make your request. Below are examples of reasons for requesting a hearing. You want a collection alternative— “I would like to propose a different way to pay the money I owe.” Common collection alternatives include: • Full payment—you pay your taxes by personal check, cashier's check, money order, or credit card. • Installment Agreement—you pay your taxes fully or partially by making monthly payments. • Offer in Compromise—you offer to make a payment or payments to settle your tax liability for less than the full amount you owe. “I cannot pay my taxes.” Some possible reasons why you cannot pay your taxes are: (1) you have a terminal illness or excessive medical bills; (2) your only source of income is Social Security payments, welfare payments, or unemployment benefit payments; (3) you are unemployed with little or no income; (4) you have reasonable expenses exceeding your income; or (5) you have some other hardship condition. The IRS Office of Appeals may consider freezing collection action until your circumstances improve. Penalty and interest will continue to accrue on the unpaid balance. You want action taken about the filing of the tax lien against your property—You can get a Federal Tax Lien released if you pay your taxes in full. You also may request a lien subordination, discharge, or withdrawal. See www.irs.gov for more information. When you request lien subordination, you are asking the IRS to make a Federal Tax Lien secondary to a non-IRS lien. For example, you may ask for a subordination of the Federal Tax Lien to get a refinancing mortgage on your house or other real property you own. You would ask to make the Federal Tax Lien secondary to the mortgage, even though the mortgage came after the tax lien filing. The IRS Office of Appeals would consider lien subordination, in this example, if you used the mortgage proceeds to pay your taxes. When you request a lien discharge, you are asking the IRS to remove a Federal Tax Lien from a specific property. For example, you may ask for a discharge of the Federal Tax Lien in order to sell your house if you use all of the sale proceeds to pay your taxes even though the sale proceeds will not fully pay all of the tax you owe. When you request a lien withdrawal, you are asking the IRS to remove the Notice of Federal Tax Lien (NFTL) information from public records because you believe the NFTL should not have been filed. For example, you may ask for a withdrawal of the filing of the NFTL if you believe the IRS filed the NFTL prematurely or did not follow procedures, or you have entered into an installment agreement and the installment agreement does not provide for the filing of the NFTL. A withdrawal does not remove the lien from your IRS records. Your spouse is responsible—“My spouse (or former spouse) is responsible for all or part of the tax liability.” You may believe that your spouse or former spouse is the only one responsible for all or a part of the tax liability. If this is the case, you are requesting a hearing so you can receive relief as an innocent spouse. You should complete and attach Form 8857, Request for Innocent Spouse Relief, to your hearing request. Other Reasons—“I am not liable for (I don't owe) all or part of the taxes.” You can raise a disagreement about the amount you owe only if you did not receive a deficiency notice for the liability (a notice explaining why you owe taxes—it gives you the right to challenge in court, within a specific timeframe, the additional tax the IRS says you owe), or if you have not had another prior opportunity to disagree with the amount you owe. “I do not believe I should be responsible for penalties.” The IRS Office of Appeals may remove all or part of the penalties if you have a reasonable cause for not paying or not filing on time. See Notice 746, Information About Your Notice, Penalty and Interest for what is reasonable cause for removing penalties. “I have already paid all or part of my taxes.” You disagree with the amount the IRS says you haven't paid if you think you have not received credit for payments you have already made.

See Publication 594, The IRS Collection Process, for more information on the following topics: Installment Agreements and Offers in Compromise; Lien Subordination, Discharge, and Withdrawal; Innocent Spouse Relief; Temporarily Delay Collection; and belief that tax bill is wrong.

Catalog Number 27779K www.irs.gov Form 12256 (Rev. 10-2012)

Form 12256 (October 2012)

Department of the Treasury - Internal Revenue Service

Withdrawal of Request for Collection Due Process or Equivalent Hearing

Taxpayer name(s)

Taxpayer address

City State Zip code

Type of tax/tax form*

Tax period(s)*

Social Security/Employer Identification Number(s)*

*Note: You may attach a copy of your Collection Due Process notice to this form instead of listing the tax type/form number/period and identification number in the spaces above.

I've reached a resolution with the Internal Revenue Service (IRS) regarding the tax and tax periods that my hearing request concerned or I am otherwise satisfied that I no longer need a hearing with the Office of Appeals (Appeals). Therefore, I withdraw my hearing request under (check all that apply):

IRC Section 6320, notice and opportunity for a hearing upon the filing of a Notice of Federal Tax Lien

IRC Section 6330, notice and opportunity for a hearing before a levy

Both IRC Section 6320 and 6330 notices

Equivalent Hearing

I understand that by withdrawing my request for a Collection Due Process hearing under Section 6320 and/or 6330:• I give up my right to a hearing with Appeals. I understand that Appeals will not issue a Notice of Determination with

respect to the tax and tax periods subject to the hearing request. As part of a CDP determination, Appeals verifies that all legal and administrative requirements were met. I understand that by withdrawing my hearing request, Appeals will not conduct this verification.

• I give up my right to seek judicial review in the Tax Court of the Notice of Determination that Appeals would have issued as a result of the CDP Hearing, as Appeals will not issue a Notice of Determination.

• I give up my right to have Appeals retain jurisdiction with respect to any determination that it would have made as a result of the CDP Hearing.

• The suspension of levy action and the suspension of the statute of limitations on the period of collection, as required under the provisions of IRC Sections 6320 and 6330, are no longer in effect upon the receipt by the IRS of this withdrawal.

• I do not give up any other appeal rights that I am entitled to, such as an appeal under the Collection Appeals Program (CAP).

I understand that by withdrawing my request for an equivalent Hearing:• I give up my right to a hearing with Appeals. I understand that Appeals will not issue a Decision Letter with respect to the tax and

tax periods subject to the hearing request. • I do not give up any other appeal rights that I am entitled to, such as an appeal under the Collection Appeals Program (CAP).

Taxpayer's signature Date

Spouse's signature (if applicable) Date

Authorized Representative signature (if applicable) Date

For privacy Act information please refer to Notice 609

Form 12277 (October 2011)

Department of the Treasury — Internal Revenue Service

Application for Withdrawal of Filed Form 668(Y), Notice of Federal Tax Lien

(Internal Revenue Code Section 6323(j)) 1. Taxpayer Name (as shown on the Notice of Federal Tax Lien) 2. Social Security/Employer Identification No.

3. Taxpayer's Representative, if applicable, or Name and Title of contact person, if taxpayer is a business

4. Address (Number, Street, P.O. Box)

5. City 6. State 7. ZIP code 8. Phone Number

9. Attach copy of the Form 668(Y), Notice of Federal Tax Lien, if available, OR, if you don't have a copy, provide the following information, if available:

Serial number of Form 668(Y) (found near the top of the document) Date Form 668(Y) filed

Recording office where Form 668(Y) was filed

10. Current status of the federal tax lien ("x" appropriate box)

Open Released Unknown

11. Reason for requesting withdrawal of the filed Notice of Federal Tax Lien ("x" appropriate box(es))

The Notice of Federal Tax Lien was filed prematurely or not in accordance with IRS procedures.

The taxpayer entered into an installment agreement to satisfy the liability for which the lien was imposedand the agreement did not provide for a Notice of Federal Tax Lien to be filed.

The taxpayer is under a Direct Debit Installment Agreement.

Withdrawal will facilitate collection of the tax.

The taxpayer, or the Taxpayer Advocate acting on behalf of the taxpayer, believes withdrawal is in thebest interest of the taxpayer and the government.

12. Explain the basis for the withdrawal request (attach additional sheets and other documentation that substantiates your request, as needed)

Affirmation

Under penalties of perjury, I declare that I have examined this application (including any accompanying schedules, exhibits, affidavits, and statements) and, to the best of my knowledge and belief, it is true, correct, and complete

Signature (Taxpayer or Representative) Title (if business) Date

Catalog Number 27939C www.irs.gov Form 12277 (Rev. 10-2011)

Page 2 of 2

General Instructions 1. Complete the application. If the information you supply is

not complete, it may be necessary for the IRS to obtain additional information before making a determination on the application.

Sections 1 and 2: Enter the taxpayer's name and Social Security Number (SSN) or Employer Identification Number (EIN) as shown on the Notice of Federal Tax Lien (NFTL).

Section 3: Enter the name of the person completing the application if it differs from the taxpayer's name in section 1 (for example, taxpayer representative). For business taxpayers, enter the name and title of person making the application. Otherwise, leave blank.

Sections 4 through 8: Enter current contact information of taxpayer or representative.

Section 9: Attach a copy of the NFTL to be withdrawn, if available. If you don't have a copy of the NFTL but have other information about the NFTL, enter that information to assist the IRS in processing your request.

Section 10: Check the box that indicates the current status of the lien. "Open" means there is still a balance owed with respect to the tax liabilities listed on the NFTL. "Released" means the lien has been satisfied or is no longer enforceable. "Unknown" means you do not know the current status of the lien.

Section 11: Check the box(es) that best describe the reason(s) for the withdrawal request. NOTE: If you are requesting a withdrawal of a released NFTL, you generally should check the last box regarding the best interest provision.

Section 12: Provide a detailed explanation of the events or the situation to support your reason(s) for the withdrawal request. Attach additional sheets and supporting documentation, as needed.

Affirmation: Sign and date the application. If you are completing the application for a business taxpayer, enter your title in the business.

2. Mail your application to the IRS office assigned your account. If the account is not assigned or you are uncertain where it is assigned, mail your application to IRS, ATTN: Advisory Group Manager, in the area where you live or is the taxpayer's principal place of business. Use Publication 4235, Advisory Group Addresses, to determine the appropriate office.

3. Your application will be reviewed and, if needed, you may be asked to provide additional information. You will be contacted regarding a determination on your application.

a. If a determination is made to withdraw the NFTL, we will file a Form 10916(c), Withdrawal of Filed Notice of Federal Tax Lien, in the recording office where the original NFTL was filed and provide you a copy of the document for your records.

b. If the determination is made to not withdraw the NFTL, we will notify you and provide information regarding your rights to appeal the decision.

4. At your request, we will notify other interested parties of the withdrawal notice. Your request must be in writing and provide the names and addresses of the credit reporting agencies, financial institutions, and/or creditors that you want notified.

NOTE: Your request serves as our authority to release the notice of withdrawal information to the agencies, financial institutions, or creditors you have identified.

5. If, at a later date, additional copies of the withdrawal notice are needed, you must provide a written request to the Advisory Group Manager. The request must provide:

a. The taxpayer's name, current address, and taxpayer identification number with a brief statement authorizing the additional notifications;.

b. A copy of the notice of withdrawal, if available; and c. A supplemental list of the names and addresses of

any credit reporting agencies, financial institutions, or creditors to notify of the withdrawal of the filed Form 668(Y).

. Privacy Act Notice

We ask for the information on this form to carry out the Internal Revenue laws of the United States. The primary purpose of this form is to apply for withdrawal of a notice of federal tax lien. The information requested on this form is needed to process your application and to determine whether the notice of federal tax lien can be withdrawn. You are not required to apply for a withdrawal; however, if you want the notice of federal tax lien to be withdrawn, you are required to provide the information requested on this form. Sections 6001, 6011, and 6323 of the Internal Revenue Code authorize us to collect this information. Section 6109 requires you to provide the requested identification numbers. Failure to provide this information may delay or prevent processing your application; providing false or fraudulent information may subject you to penalties.

Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

Catalog Number 27939C www.irs.gov Form 12277 (Rev. 10-2011)

Form 14134 (June 2010)

Application for Certificate of Subordination ofFederal Tax Lien

Department of the Treasury — Internal Revenue Service

OMB No. 1545-2174

Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be included as necessary. Additional information may be requested to clarify the details of the transaction(s).

1. Taxpayer Information (Individual or Business named on the notice of lien)

Name (Individual First, Middle Initial, Last) or (Business) as it appears on lien

Name Continuation (Individual First, Middle Initial, Last) or (Business d/b/a)

Address (Number, Street, P.O. Box)

Primary Social Security Number

(last 4 digits only)

Secondary Social Security Number

(last 4 digits only)

Employer Identification Number

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

2. Applicant Information Check if also the Taxpayer (If not the taxpayer, attach copy of lien. See Sec.10)

Name (First, Middle Initial, Last) Relationship to taxpayer

Address (Number, Street, P.O. Box)

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

3. Property Owner Check if also the Applicant

Relationship to Taxpayer

4. Attorney/Representative Information Attached: Form 8821 orPower of Attorney Form 2848 Yes No

Name (First, Middle Initial, Last) Interest Represented (e.g. taxpayer, lender, etc.)

Address (Number, Street, P.O. Box)

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

5. Lending/Finance Company Company Name Contact Name Contact Phone Number

Type of transaction (For example, loan consolidation, refinance, etc)

Catalog Number 54726H www.irs.gov Form 14134 (Rev. 06-2010)

Page 2 of 3

6. Monetary Information

Amount of existing loan (if refinancing)

Amount of new loan

Amount to be paid to the United States (6325(d)(1) applications only)

7. Basis for Subordination: Check the box below that best addresses what you would like the United States to consider in your application for subordination. (Publication 784 has additional descriptions of the Internal Revenue Code sections listed below.)

6325(d)(1) the United States will receive an amount equal to the lien or interest to which the certificate of subordination is issued (provide amount in Section 6 above)

6325(d)(2) the issuance of the certificate of subordination will increase the government's interest and make collection of the tax liability easier. (Complete and attach a signed and dated statement describing how the amount the United States may ultimately realize will increase and how collection will be facilitated by the subordination.)

Statement Attached NA

8. Description of property (For example, 3 bedroom rental house; 2002 Cessna twin engine airplane, serial number AT919000000000X00; etc.):

Address of real property (If this is personal property list the address where the property is located): Address (Number, Street, P.O. Box)

City State ZIP Code

Real Estate: Legible copy of deed or title showing legal description Attached NA

9. Appraisal and Valuations

Appraisal: (Professional appraisal completed by a disinterested third party but it is not required for a subordination)

Attached

OR ONE OF THE FOLLOWING VALUATIONS:

County valuation of property (real property) Attached

Informal valuation of property by disinterested third party Attached

Proposed selling price (for property being sold at auction) Attached

Other: Attached

Catalog Number 54726H www.irs.gov Form 14134 (Rev. 06-2010)

No No Yes Yes

Page 3 of 3 10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ) Attached No

OR list the lien number(s) found near the top right corner on the lien document(s) (if known)

11. Copy of the proposed loan agreement (if available) Attached No AND Describe how subordination is in the best interests of the United States:

12. Copy of a current title report (required for subordination) Attached No OR

List encumbrances with seniority over the Federal Tax Lien. Include name and address of the holder; description of the encumbrance, e.g., mortgage, state lien, etc.; date of agreement; original loan amount and interest rate; amount due at time of application; and family relationship, if applicable. Include any home equity line of credit (HELOCs) advances beginning the 46th day after the NFTL was filed, through the date you submit your application, and include expected advances through the date the certificate will be issued. (Attach additional sheets as needed):

13. Copy of proposed closing statement (aka HUD-1) Attached No OR

Itemize all proposed costs, commissions, and expenses of any transfer or sale associated with property (Attach additional sheets as needed):

14. Additional information that may have a bearing on this request, such as pending litigation, explanations of unusual situations, etc., is attached for consideration

Yes No

15. Declaration Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules, exhibits, affidavits, and statements and to the best of my knowledge and belief it is true, correct and complete.

Signature/Title Date

Signature/Title Date

Catalog Number 54726H www.irs.gov Form 14134 (Rev. 06-2010)

Form 14135 (June 2010)

Application for Certificate of Discharge ofProperty from Federal Tax Lien

Department of the Treasury — Internal Revenue Service

OMB No. 1545-2174

Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be included as necessary. Additional information may be requested of you or a third party to clarify the details of the transaction(s).

1. Taxpayer Information (Individual or Business named on the notice of lien):

Name (Individual First, Middle Initial, Last) or (Business) as it appears on lien

Name Continuation (Individual First, Middle Initial, Last) or (Business d/b/a)

Address (Number, Street, P.O. Box)

Primary Social Security Number (last 4 digits only)

Secondary Social Security Number (last 4 digits only)

Employer Identification Number

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

2. Applicant Information: Check if also the Taxpayer (If not the taxpayer, attach copy of lien. See Sec.10)

Name (First, Middle Initial, Last) Relationship to taxpayer

Address (Number, Street, P.O. Box)

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

3. Purchase/Transferee/New Owner Check if also the Applicant

Relationship to taxpayer

4. Attorney/Representative Information Power of Attorney Form 2848 Attached: Form 8821 or Yes No

Name (First, Middle Initial, Last) Interest Represented (e.g. taxpayer, lender, etc.)

Address (Number, Street, P.O. Box)

City State ZIP Code

Telephone Number (with area code) Fax Number (with area code)

5. Lender/Finance Company Information - or (Settlement/Escrow Company for applications under Section 6325(b)(3) only)

Company Name Contact Name Contact Phone Number

Catalog Number 54727S www.irs.gov Form 14135 (Rev. 06-2010)

Page 2 of 3

6. Monetary Information

Proposed sales price

Expected proceeds to be paid to the United States in exchange for the certificate of discharge (Enter NA if no proceeds are anticipated)

7. Basis for Discharge: Check the box below that best addresses what you would like the United States to consider in your application for discharge. (Publication 783 has additional descriptions of the Internal Revenue Code sections listed below.)

6325(b)(1) Value of property remaining attached by the lien(s) is at least double the liability of the federal tax lien(s) plus other encumbrances senior to the lien(s)

6325(b)(2)(A) The United States receives an amount not less than the value of the United States' interest. (Note: If you are applying under 6325(b)(2)(A) and are the property owner but not the taxpayer, see also section 16.)

6325(b)(2)(B) Interest of the United States in the property to be discharged has no value.

6325(b)(3) Proceeds from property sale held in escrow subject to the liens and claims of the United States.

6325(b)(4) Deposit made or bond furnished in an amount equal to the value of the United States' interest. (Note: This selection provides a remedy under 7426(a)(4) for return of deposit but is exclusively for a property owner not named as the taxpayer on the lien)

8. Description of property (for example, 3 bedroom rental house; 2002 Cessna twin engine airplane, serial number AT919000000000X00; etc.):

Address of real property (If this is personal property, list the address where the property is located):

Address (Number, Street, P.O. Box)

City State ZIP Code

FOR REAL ESTATE: a legible copy of the deed or title showing the legal description is required Attached NA

FOR Discharge Requests under Section 6325(b)(1): copy of deed(s) or title(s) for property remaining subject to the Federal Tax Lien is required

Attached NA

9. Appraisal and Valuations

REQUIRED APPRAISAL Professional appraisal completed by a disinterested third party Attached

PLUS ONE OF THE FOLLOWING ADDITIONAL VALUATIONS:

County valuation of property (real property) Attached Informal valuation of property by disinterested third party Attached

Proposed selling price (for property being sold at auction) Attached

Other: Attached

AND for applications under Section 6325(b)(1), valuation information (of the type described above in this section) must also be provided for property remaining subject to the lien.

Catalog Number 54727S www.irs.gov Form 14135 (Rev. 06-2010)

Page 3 of 3 10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ) Attached No

OR list the lien number(s) found near the top right corner on the lien document(s) (if known)

11. Copy of the sales contract/purchase agreement (if available) Attached No OR Describe how and when the taxpayer will be divested of his/her interest in the property:

12. Copy of a current title report Attached No OR

List encumbrances senior to the Federal Tax Lien. Include name and address of holder; description of encumbrance, e.g., mortgage, state lien, etc.; date of agreement; original loan amount and interest rate; amount due at time of application; and family relationship, if applicable (Attach additional sheets as needed):

13. Copy of proposed closing statement (aka HUD-1) Attached No OR

Itemize all proposed costs, commissions, and expenses of any transfer or sale associated with property (Attach additional sheets as needed):

14. Additional information that may have a bearing on this request, such as pending litigation, explanations of unusual situations, etc., is attached for consideration

Attached No

15. Escrow Agreement (For applications under IRC 6325(b)(3)) Attached No Escrow agreement must specify type of account, name and depositary for account, conditions under which payment will be made, cost of escrow, name and address of any party identified as part of escrow agreement, and signatures of all parties involved including Advisory Group Manager. Terms for agreement must be reached before discharge approved.

16. WAIVER (For applications made by third parties under IRC 6325(b)(2)) If you are applying as an owner of the property and you are not the taxpayer, to have this application considered under section 6325(b)(2), you must waive the rights that would be available if the application were made under section 6325(b)(4). If you choose not to waive these rights, the application will be treated as one made under 6325(b)(4) and any payment will be treated like a deposit under that section. Please check the appropriate box.

I understand that an application and payment made under section 6325(b)(2) does not provide the judicial remedy available under section 7426(a)(4). In making such an application / payment, I waive the option to have the payment treated as a deposit under section 6325(b)(4) and the right to request a return of funds and to bring an action under section 7426(a)(4). Waive No

17. Declaration Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules, exhibits, affidavits, and statements and to the best of my knowledge and belief it is true, correct and complete.

Signature/Title Date

Signature/Title Date

Catalog Number 54727S www.irs.gov Form 14135 (Rev. 06-2010)

[Date]

Internal Revenue Service

Attn:

Re: [Company]

EIN:

Dear __________,

Please allow the following correspondence to serve as a formal Installment Agreement request

for the aforementioned taxpayer. It is proposed and requested that__[taxpayer]__________ be

granted an Installment Agreement to resolve in full their outstanding tax liabilities for the

following forms and periods:

Forms ____ for periods ending _____

All other forms and periods for which a liability exists.

The terms of the proposal are as follows:

Payments would be made on the -----th of each month beginning --------th, 2011.

Payments will be equal to $__________ per month until the liability is full paid.

This request is being made under the provisions for [Guaranteed/Streamlined/In Business Trust

Fund Express/In Business Trust Fund/Routine/Partial Payment] Installment Agreements, and

[will/will not] be paid via direct debit. Per the Internal Revenue Manual, this Installment

Agreement request [does/does not] require a Collection Information Statement, and therefore a

Form [433-A / Form 433-B] [is/is not] currently being prepared. Please notify me of any

additional financial information you will need from my client.

My client is aware that an Installment Agreement is a privilege rather than a right. They have

been advised that they will be held to the strictest standards with regard to future Federal Tax

Deposits and monthly installment payments.

I can be reached at [phone] with any questions you might have. I understand that there will be no

enforcement action while this proposal is under consideration; please notify me immediately if

this is incorrect.

Sincerely,