Offer in Compromise: Form 656

IRS
Department of the Treasury

Internal Revenue Service
www.irs.gov
Form 656 (Rev. 02-2007)

Catalog Number 16728N
Form 656
Offer in
Compromise
IMPORTANT! THIS BOOKLET CONTAINS INFORMATION THAT YOU
NEED IN ORDER TO PREPARE A COMPLETE AND ACCURATE OFFER
IN COMPROMISE. PLEASE READ THESE INSTRUCTIONS CAREFULLY
BEFORE ATTEMPTING TO COMPLETE THE ENCLOSED FORMS.
CONTENTS
■ What is an Offer in Compromise?................................................................1
■ Step One: Is Your Offer in Compromise “Processable”?..................................2
■ Step Two: What We Need to Fully Evaluate Your Offer........................................ 3
■ Step Three: Determining the Amount of Your Offer...................................5
■ Step Four: Completing Form 656, Offer in Compromise.........................10
■ Step Five: Offer in Compromise Application Fee and Payments.............12
■ Step Six: Where you need to Send Your Offer.........................................14
■ Step Seven: What to Expect After the IRS Receives Your Offer..............15
■ Step Eight: Offer in Compromise Summary Checklist.............................17
■ Important Information You Need To Know Regarding the
Offer in Compromise................................................................................18
■ Terms and Definitions...............................................................................19
■ Removable Forms – Form 656, Offer in Compromise Application Fee
and Payment Worksheet, Form 656-A, Form 656 - PPV, Form 433-A,
and Form 433-B,......................................................................................21
Note: If you have any questions, please call our toll-free number at 1-800-829-1040. You can get
forms and publications by calling toll free at 1-800-829-3676 (1-800-TAX-FORM), or by visiting
your local Internal Revenue Service (IRS) office or our web site at www.irs.gov.
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What is an
Offer in Compromise?
An Offer in Compromise (OIC) is an the taxpayer owes part or all of the

agreement between the taxpayer and assessed tax liability. To submit a
the government that settles a tax Doubt as to Liability OIC, the taxpayer
liability for payment of less than the must use Form 656-L, which can
full amount owed. be obtained by calling the toll free
number 1-800-829-1040, or by visiting
The IRS will generally accept an Offer their local IRS office, or our web site
in Compromise when it is unlikely that at www.irs.gov.
the tax liability can be collected in full
and the amount offered reasonably n Effective Tax Administration (ETA).
reflects collection potential. An OIC is This means that the taxpayer does
a legitimate alternative to declaring a not have any doubt that the tax is
case currently not collectible or to a correct and there is potential to collect
protracted installment agreement. The the full amount of the tax owed, but an
goal is to achieve collection of what exceptional circumstance exists that
is potentially collectible at the earliest would allow us to consider an offer.
possible time and at the least cost to the To be eligible for compromise on this
government. basis, a taxpayer must demonstrate
that the collection of the tax would
The success of the Offer in Compromise create an economic hardship or would
program will be assured only if taxpayers be unfair and inequitable. For an ETA
make adequate compromise proposals offer, a taxpayer must submit:
consistent with their ability to pay and
the Service makes prompt and reason- 1. A collection information statement
able decisions. Taxpayers are expected with all appropriate attachments,
to provide reasonable documentation and
to verify their ability to pay. The ultimate 2. A written narrative explaining the
goal is a compromise which is in the taxpayer’s special circumstances
best interest of both the taxpayer and and why paying the tax liability
the Service. Acceptance of an adequate in full would create an economic
offer will also result in creating for the hardship or would be unfair and
taxpayer an expectation of, and a fresh inequitable.
start toward, compliance with all future
The taxpayer must also attach appro-
filing and payment requirements.
priate documentation that will support
n Doubt as to Collectibility. This their request for an ETA offer such as
means that doubt exists that the proof of unusual expenses that would
taxpayer could ever pay the full cause an economic hardship if the
amount of tax liability owed within taxes were collected in full.
the remainder of the statutory period
for collection. The IRS will consider a Note: An important factor in determining
doubt as to collectibility offer (absent the type of offer to submit is the potential
special circumstances) when the ability to pay the liability in full. If the
taxpayer is unable to pay the taxes taxpayer cannot pay their liability in full,
in full either by liquidating assets or then they should submit a Doubt as to
through current installment agree- Collectibility offer. However, if potential
ment guidelines. The taxpayer must exists to pay their liability in full, but the
submit the appropriate collection collection of the tax would create an
information statement along with economic hardship or would be unfair or
all required supporting documents. inequitable, then they should submit an
Effective Tax Administration (ETA) offer.
n Doubt as to Liability. This means
that a legitimate doubt exists that

Step One: Is Your Offer in Compromise
“Processable?”
STOP
PLEASE DO NOT GO ANY FURTHER WITHOUT FIRST DETERMINING WHETHER OR NOT YOU
ARE ELIGIBLE TO HAVE YOUR OFFER IN COMPROMISE PROCESSED AT THIS TIME.
In order to determine whether or not you are eligible to have your Offer in Compromise processed, please
answer the three questions below:
YES NO
1. Do you currently have an open bankruptcy proceeding? You should contact your Bankruptcy
Attorney if you are not certain. If you are involved in an open bankruptcy proceeding, contact
your local IRS Insolvency office. If you do not know the location of your local IRS Insolvency
office, then you may call 1-800-829-1040. They will be able to provide you with the local number.
Any resolution of your outstanding tax liabilities generally must take place within the context of
your bankruptcy proceeding. If you answered YES to this question, then stop here. You are not
eligible to have your offer considered or processed at this time.
2. Offer in Compromise Application Fee — Your offer must include the $150 application fee or
a completed Form 656-A, Income Certification for Offer in Compromise Application Fee and
Payment, if you are requesting an exception of the fee because of your income. Offers received
without the $150 fee or a completed Form 656-A will not be accepted for processing. Please see
Step Five on Page 12 of this package for more information on the application fee and to deter-
mine if you qualify for the exception.
Have you attached the $150 application fee or the Form 656-A, which ever is applicable, to the
Form 656? If you answered NO to this question, Stop Here. You are not eligible to have your
offer considered or processed at this time.
3. Cash payment and Periodic Payment Offers — Your offer must include your 20% payment
for Lump Sum Cash payment offers, or your first installment payment of your Periodic Payment
offer (Short Term or Deferred). If you are requesting an exception to the 20% down payment or
your initial periodic payment because of your income level, then you must complete Form 656-A,
Certification of Offer in Compromise Application Fee and Payment. Offers received without one
of these will not be accepted for processing. Please see Step Five on Page 12 of this package for
more information on the Cash Payment and Periodic Payment Offer.
Have you attached either the 20% payment for Lump Sum Cash payment offers or your first
installment payment for a Periodic Payment Offer, or, the Form 656-A? If you answered NO to
this question, Stop Here. You are not eligible to have your offer considered or processed at this
time.
NOTE: If you currently have an approved installment agreement with IRS and are currently making
installment payments to IRS, then you may stop making those installment agreement payments
when you submit a Periodic Payment offer. This will allow you to make your payments required
under the Periodic Payment guidelines. You do not have to make both installment agreement
payments and periodic payments at the same time.
However this procedure does not apply to Lump Sum Cash Offers. If you submit a Lump
Sum Cash offer and you are currently making installment agreement payments, then you must
continue to make your installment agreement payments until your offer is accepted. If it is not
accepted, then installment agreement payments must continue.

Step Two: What We Need to Fully Evaluate
Your Offer
1. You must file all tax returns that you date. If we determine this to be the
were legally required to file prior to case, you will have one opportunity to
submitting an Offer in Compromise. make the required payments before
If you have not filed all required tax we return your offer.
returns, you will be asked to do so
before we begin to evaluate your NOTE: If you fail to comply with
offer. items 1, 2, and 3, then your offer
This includes but is not limited to: will be returned to you and we will
keep your $150 application fee as
n All Income Tax, Employment Tax, well as any payments you made
and Excise Tax returns, along with with your offer, such as the 20%
all returns required to be filed by payment or your first installment.
Partnerships, Limited Liability
Companies, or closely held Sub- 4. COMPLETE AN ACCURATE
Chapter S Corporations. FORM 656 — Complete all applicable
items on Form 656, which is the
If you did not file a return for a official compromise agreement.
specific year prior to submitting your You must sign Form 656. If someone
OIC because you were not legally else prepared the offer package, then
required to file the return, then you please see the instructions in Step
must include a detailed explanation Four, Section IX and X, found on
of your circumstances with your OIC. Page 11 of this package. If your Form
If you used an employee leasing 656 was prepared by an authorized
company for all or part of the time representative, you must include
during the past three years, then a completed Form 2848, Power
please provide a detailed explanation of Attorney and Declaration of
of your circumstances with your offer Representative, with your offer, unless
by providing the exact dates you a copy is already on file with the IRS
used the employee leasing company, Detailed instructions for the comple-
the name and address of the leasing tion of Form 656 are found on Pages
company, and EIN of the leasing 10 and 11 of this package.
company, and whether or not you are
still using them. Common errors to avoid in
completing Form 656:
2. If you are a business with employees,
then you must have made all required n The taxpayer’s name is missing.
federal tax deposits for the current n The street address is missing or
quarter. If you have not made all incomplete.
the required deposits, you will be n The social security number (SSN)
asked to do so before we begin to or employer identification number
evaluate your offer. In addition, you (EIN) is missing, incomplete, or
must remain current on all filing and incorrect.
deposit requirements while your offer
is being investigated. n The preprinted terms and condi-
tions listed on the Form 656 have
3. ESTIMATED TAX PAYMENTS been altered or deleted.
MUST BE UP TO DATE FOR THE
CURRENT YEAR — We will not n An offer amount or payment term
process your offer to completion if is missing.
we determine that your estimated n A required signature is missing.
tax payments for the current year’s
income tax liability are not paid up to

5. COMPLETE AN ACCURATE to the household. This is necessary
COLLECTION INFORMATION for the IRS to evaluate the income
STATEMENT (Form 433-A and/or and expenses allocable to the liable
Form 433-B) — You must provide taxpayer.
financial information when you submit
In states with community property
offers based on doubt as to collect-
laws, we require collection informa-
ibility and effective tax administration.
tion statements from both spouses.
You must send us current information
We may also require financial infor-
that reflects your financial situation for
mation on the non-liable spouse, or
the three months immediately prior
cohabitant(s), for offer verification
to the date you submitted your Offer
purposes, even when community
in Compromise. Collection informa-
property laws do not apply.
tion statements must show all assets
and income. The offer investigator 6. RESPOND PROMPTLY TO
needs this information to evaluate REQUESTS FOR ADDITIONAL
your offer and may ask you to update INFORMATION — While we are
it or verify certain financial informa- evaluating your offer, we may
tion. These forms must be filled in contact you for any information that
completely. We may return offer pack- is missing or requires clarification.
ages that are incomplete. Annotate You must respond within the time
items that do not apply to you with frame given to you by IRS or, we will
“N/A.” Provide all the information not give your offer any further consid-
required to support your financial eration. Your offer will be returned
condition. Required items of docu- to you and we will keep your $150
mentation are clearly indicated on the application fee as well as any
collection information statements payments you made with your offer
with attachment symbols. Photo such as the 20% payment or your
copies of these support documents first installment.
are acceptable.
7. WE WILL NOT CONSIDER OFFERS
When only one spouse has a tax WHERE LIABILITIES HAVE NOT
liability but both have incomes, only BEEN ASSESSED — You can not
the spouse responsible for the tax submit an offer that is solely for a tax
debt is required to sign the necessary year or tax period that has not been
collection information statements. assessed. Your offer will be returned
The responsible spouse should if you submit an offer that is solely for
include only his/her assets and an unassessed tax year or tax period
liabilities on his/her collection and you will forfeit your application
information statements. However, fee and payment.
the income and expenses of the
8. Make copies of removable
entire household is required on
forms and documents — This
the responsible spouse’s collec-
is a reminder that you should make
tion information statements. The
copies of all the removable forms and
entire household includes spouse,
documents that you send to the IRS.
domestic partner, significant other,
You should keep these copies with
children, and others that contribute
your records.

Step Three: Determining the Amount of
Your Offer
Doubt as to Collectibility may include factors such as advanced

Your offer amount must equal or age, serious illness from which recovery
exceed your reasonable collection is unlikely, or any other factors that have
potential amount. The information an impact upon your ability to pay the
provided on the collection information total RCP and continue to provide for the
statements (Form 433-A and Form 433- necessary living expenses for you and
B) assists us in determining the reason- your family.
able collection potential (RCP). The If you are a wage earner or self-
RCP equals the net equity of your assets employed individual, completion of the
plus the amount we could collect from worksheet on Pages 8 and 9 will give
your future income. If our financial you a good estimate of what an accept-
analysis indicates that you have the able offer amount may be. You will use
ability to fully pay the tax liability, the information on your Form 433-A to
either immediately or through an complete the worksheet.
installment agreement, your offer
will be rejected. Exception: special Effective Tax Administration (ETA)
circumstances. Please see below
Complete Form 433-A or Form 433-B,
for more information on special
as appropriate, and attach to Form 656.
circumstances. You must offer an
You must complete Section VI, “Expla-
amount greater than or equal to the
nation of Circumstances,” on Form 656,
RCP amount. All offer amounts must
explaining your exceptional circum-
exceed zero. stances and why requiring payment of
If special circumstances cause you to the tax liability in full would either create
offer an amount less than the RCP, you an economic hardship or would be unfair
must complete Section VI, “Explana- and inequitable. You must also attach
tion of Circumstances,” on Form 656, to Form 656 any documents to help
explaining your situation. You must support your exceptional circumstances.
also attach to Form 656 any supporting
documents to help support your special
circumstances. Special circumstances

Determine Your There are three payment plans you and We may file a Notice of Federal Tax
Payment Terms the IRS may agree to: Lien on tax liabilities to be compro-
mised under Short Term Periodic
n Lump Sum Cash Offer – This option
Payment Offer.
requires the offer amount to be paid
in five or fewer installments, upon n Deferred Periodic Payment Offer –
written notice of acceptance. Twenty This option requires you to pay the
percent of the total amount of the offer amount over the remaining statu-
offer must be paid when you submit tory period for collecting the tax. This
the Form 656. offer option must include the realizable
value of your assets plus the amount
If these installments will be paid in five
we could collect through monthly
months or less, you should offer the
payments during the remaining life of
realizable value of your assets plus the
the collection statute. As with the Short
total amount we could collect over 48
Term Periodic Payment above, the
months of payments (or the remainder
first payment must be submitted with
of the statutory period for collection,
your Form 656. You must make regular
whichever is less).
payments during your offer investiga-
If these installments will be paid in tion. Failure to make regular payments
more than five months, you should during your offer investigation will
offer the realizable value of your cause your offer to be withdrawn.
assets plus the total amount we
NOTE: Generally the collection
could collect over 60 months of
statute is 10 years from the
payments ( or the remainder of the date that your liability was
statutory period for collection, which- assessed. You can call the toll
ever is less.) free number 1-800-829-1040
We may file a Notice of Federal Tax for assistance in calculating
Lien on tax liabilities to be compro- the remaining time on your
mised under Lump Sum Cash Offer. collection statute.
n Short Term Periodic Payment Use the worksheet on pages 8 and 9,
Offer – This option requires the offer multipy the amount from item 12, Box
amount to be paid within 24 months 0, by the number of months remaining
from the date IRS received the offer. on the collection statute. Add that
The first payment must be submitted amount to item 11, Box N, and use the
with your Form 656. You must total as the basis for your offer amount
continue to make regular payments in Section IV of Form 656.
during your offer investigation. Failure As with Short Term Periodic
to make regular payments during your Payment Offers, we may file a
offer investigation will cause your offer Notice of Federal Tax Lien on tax
to be withdrawn. liabilities to be compromised under
The offer must include the realizable Deferred Periodic Payment Offer.
value of your assets plus any amount Note: The worksheet on Pages 8
we could collect over 60 months of and 9 instructs wage earners
payments (or the remainder of the and self-employed individuals
statutory period of collection, which- how to figure the appropriate
ever is less.) If you do not have this amount for Lump Sum Cash,
information you may call our toll free Short Term Periodic Payment
number at 1-800-829-1040. and Deferred Periodic
Payment Offers.

Offer in Compromise Worksheet
Please see Pages 8 and 9.
Funding Your Offer
If you do not have the cash to pay your

offer amount immediately, you should
begin the process of exploring options
to finance your offer amount. Options
you may want to consider include
liquidating assets, obtaining a loan from
a lending institution, borrowing on your
home equity through a second mortgage
or reverse mortgage, or borrowing funds
from family members or friends.

Keep this worksheet
worksheet for
foryour
yourrecords.
records.
Worksheet to Calculate an Offer Amount Do not send to
to IRS.
IRS.
For use by Wage Earners and Self-Employed Individuals.
1. Enter total checking account balances from Item 11c A

Use this Worksheet to
calculate an offer amount
using information from 2. Enter total other account balances from Item 12c
B
Form 433-A. If less than 0 , enter 0
3. Enter total investments from Item 13d C
4. Enter total cash on hand from Item 14a D
5. Enter life insurance cash value from Item 16f E
6. Enter total accounts/notes receivable from Item 23m F
G
Subtotal: Add boxes A through F =
7. Purchased Automobiles, Trucks, and Other Licensed Assets Individual
r
asset value
Enter current value Enter loan balance (if less than 0 ,
for each asset for each asset enter 0 )
o
From line 18a $ x .8 = $ —$ =
f
From line 18b $ x .8 = $ —$ =
From line 18c $ x .8 = $ —$ =
is
H
Subtotal =
th rd s
8. Real Estate
Enter current value Enter loan balance
Individual
asset value
(if less than 0 ,
p
o
From line 20a $ x .8 = $ —$ =
e c
From line 20b $ x .8 = $ —$ =
e
I
e
Subtotal =
K ur r
9. Personal Assets Individual
asset value
From line 21b $ x .8 = $ —$ =
From line 21c $ x .8 = $ —$ =
o
From line 21d $ x .8 = $ —$ =
y
From line 21e $ x .8 = $ —$ =
J
Subtotal =
From line 21a $ x .8 = $ —$ =

Subtract — $ 7720.00
Subtotal = K
10. Business Assets Individual

asset value
From line 22b $ x .8 = $ —$ =

From line 22c $ x .8 = $ —$ =
From line 22d $ x .8 = $ —$ =
From line 22e $ x .8 = $ —$ =
L
Subtotal =
From line 22a $ x .8 = $ —$ =

Subtract — $ 3860.00
M
Subtotal =

11. Add amounts in Boxes G through M to obtain your total equity and assets = N
12. Enter amount from Item 34 $

If Box O is 0 or less, STOP. Use
Enter amount from Item 45 and subtract — $ the amount from Box N to base
your offer amount in Section IV of Form
O 656. Your offer amount must equal
Net Difference =
or exceed (*) the amount shown in
This amount would be available Box N.
to pay monthly on your tax liability.
13a. 13b.
If you will pay the offer amount If you will pay the offer amount in more
in 55 months
months oror less:
less: than 5 months but less than 2 years:
Enter amount Enter amount

from Box O $ from Box O $
Multiply by x 48 Multiply by x 60
(or the number of months (or the number of months
r
remaining on the ten-year remaining on the ten-year
statutory period for collection, statutory period for collection,
o
whichever is less) whichever is less)
f
= P
= S
Enter amount Enter amount

from Box N + Q
from Box N + T
is
Add amounts = R Add amounts = U
in Box P and in Box S and
s
Box T
h
Box Q Use the amount Use the amount
t
from Box R to base from Box U to base
d
your offer amount your offer amount
r
in Section IV of Form in Section IV of Form
656. 656.
p o
Note: Your offer Note: Your offer
amount must equal amount must equal
e c
or exceed (*) the or exceed (*) the
amount shown in amount shown in
e e
Box R. Box U.
K ur r
Note: Do not compute your offer amount using 13a or 13b if your
statute expiration date(s) is less than five years from the date of your
offer. Instead, refer to Page 6 under Deferred Payment Offer.
o
* Unless you are submitting an offer under effective tax administration or doubt as to collectibility
y
with special circumstances considerations, as described on Page 1.
By law, the IRS has the authority to collect outstanding federal taxes for ten years from the date
your liability is assessed. There may be circumstances that extend the ten year collection statute
such as when a taxpayer files bankruptcy or an Offer in Compromise.
The IRS may adjust the RCP during the investigation to a higher or lower amount, depending
upon the facts and circumstances of your individual case.

Step Four: Completing Form 656, Offer in Compromise
Note: If you have any questions about completing this form, you may call toll free at
1–800–829–1040 or visit your local IRS office or our website at www.irs.gov.
We may return your offer if you fail to follow these instructions.
Section I: Enter your name and home or business your Form 656 and submit one $150
street address. Show both names on application fee (or Form 656-A, if
a joint offer for joint liabilities. You also applicable) and payment (20% of offer
should include a mailing address if it is amount or first initial payment). The other
different from your street address. person should show only the joint tax
liability on their Form 656 and submit one
If you owe a liability — $150 application fee (or Form 656-A, if
Jointly with another person and both of applicable) and payment (20% of amount
you agree to submit an offer, send only offered or first initial payment)
one Form 656, Offer in Compromise,
and one $150 application fee (or Form Please see the matrix in Step 5, Page 12,
656-A, if applicable) and one payment for further instructions and examples.
(20% of the amount offered or first initial
payment). Enter the social security number(s)
for the person(s) submitting the offer. For
By yourself (such as employment taxes), example, enter the social security number
and other liabilities with another person of both spouses when submitting a joint
(such as income taxes), but only you offer for a joint tax liability. However,
are submitting an offer, then list all tax when only one spouse submits an offer,
liabilities on one Form 656 and submit enter only that spouse’s social security
one $150 application fee (or Form 656-A, number
if applicable) and one payment (20% of
amount offered or first initial payment). Enter the employer identification number
for offers from businesses.
By yourself and another one jointly,
and both of you submit an offer, then Show the employer identification
you must show all tax liabilities on numbers for all other businesses that you
own or in which you have an ownership
interest, even if they are not included in
the offer.
Section II: Identify the type of tax liability you owe Federal Tax Lien show the tax periods for
and enter the tax year or period. Letters trust fund recovery penalties.
and notices from us and Notices of
Section III: Check the appropriate box(es) Effective Tax Administration offers
describing the basis for your offer. require you to complete a Form 433-A,
Collection Information Statement for
Doubt as to Collectibility offers require Wage Earners and Self-Employed
you to complete a Form 433-A, Collection Individuals, if you are an individual
Information Statement for Wage Earners taxpayer, or a Form 433-B, Collection
and Self-Employed Individuals, if you are Information Statement for Businesses,
an individual taxpayer, or a Form 433- if you are a corporation or other
B, Collection Information Statement for business taxpayer. Complete Section VI,
Businesses, if you are a corporation or other “Explanation of Circumstances.”
business taxpayer.
Note: Attach to the upper left corner of Form 656 the six (6) pages of the collection
information statement(s) and all related documents before you send it to us.
10
Section IV: Enter the total amount of your offer Check the appropriate payment box (Lump
(see Page 5, Step Three, “Determining Sum Cash Offer, Short Term Periodic
the Amount of Your Offer”). Your offer Payment Offer, or Deferred Periodic
amount cannot include a refund we Payment Offer — see Page 6, “Determine
owe you or amounts you have already Your Payment Terms”) and describe your
paid. payment plan in the spaces provided.
Section V: It is important that you understand and (g), as they address the future
the requirements listed in this section. compliance provision and refunds.
Pay particular attention to Items (d), (f)
Section VI: Explain your reason(s) for submitting additional sheets if necessary.
your offer in the “Explanation of Include your name and SSN or EIN
Circumstances.” You may attach on all attachments.
Section VII: Explain where you will get the funds to

pay the amount you are offering.
Section VIII: All persons submitting the offer must executors, trustees, Powers of Attorney,
sign and date Form 656. Include titles of etc., where applicable.
authorized corporate officers,
Section IX: If someone other than the taxpayer taxpayer should insert the name and
prepared this Offer in Compromise, the address of the preparer (if known) in
Section IX.
Section X: Paid Preparer Use Only. Please see the “Privacy Act Notice” in
Form 656.
Section XI: If you want to allow the IRS to discuss This additional information may include
your Offer in Compromise with a friend, information about tax liabilities you
family member, or any other person, failed to list in Section II on your Form
including an individual you paid to 656 or returns you have failed to file. If
prepare this form, check the “Yes” box your contact person is an attorney, CPA,
in Section XI, “Third Party Designee,” on or enrolled agent and you wish to have
your Form 656. Also enter the designee’s them represent you regarding this offer,
name and phone number. Checking a Form 2848, Power of Attorney and
the “Yes” box allows the IRS to contact Declaration of Representative, should
another person and discuss with that be completed and submitted with your
person any additional information offer.
the IRS needs to process your offer.
Note: Staple in the upper left corner the four (4) pages of Form 656 before you
send it to us.
11
Step Five: Offer in Compromise Application Fee and
Payments
Two people Two people

Individual
Two people have joint have joint
Corporation Partnership and Corpo-
One person are liable liabilities but liabilities and
is proposing is proposing rate or
is liable for one joint want to file one has joint
an offer an offer Partnership
liability separate and separate
liabilities
offers liabilities
1 1 2 2 1 1 2
Each will One with

Number of show the the joint and
Forms 656 joint liabilities the 2nd with
required the joint and
separate
liabilities
Number of 1 - $150 fee 1 - $150 2 - $150 2 - $150 1 - $150 1 - $150 2 - $150
fees to be
sent with the
Form 656*
Lump Sum 20% of the 20% of the 20% for 20% for 20% of the 20% of the 20% for
Cash Offer amount amount each offered each offered amount amount each offered
amount to be offered offered amount amount offered offered amount
sent with the
Form 656
Amount First First First First First First First
to be sent payment payment payment for payment for payment payment payment
with the amount amount each offer each offer amount amount for each
Short Term shown in shown in that is shown that is shown shown in shown in offer that is
or Deferred Section IV of Section IV of in Section IV in Section IV Section IV of Section IV of shown in
Periodic the Form 656 the Form 656 of the Form of the Form the Form 656 the Form 656 Section IV of
Payment 656 656 the Form 656
Offer
A. The application fee and payment are due on all offers at the time you submit your offer. Please staple
both the application fee and payment to the front of your Form 656. Any offer submitted without the
application and payment will be returned to you without further consideration.
* EXCEPTION: If you certify that your total monthly household income is at or below levels based
on the IRS OIC Low Income Guidelines, then you may be exempt from the application fee and the
payment (20% of the amount offered or the initial payment) as described above. The exception
for taxpayers with incomes below these levels only apply to individuals. It does not apply to other
entities such as corporations, partnerships, and LLC.’s.
To determine if you qualify for the exemption, please complete the attached Offer in Compromise
Application Fee and Payment Worksheet. If you do qualify, then you must complete and sign form
656A.
B. Do not send cash. Please make all checks or money orders payable to the “United States Treasury”.
C. The application fee can only be returned to you if the IRS determines that your offer is not process-
able. If your offer is determined to be not processable (see Page 2 for the 3 processable require-
ments), then IRS will return your application fee.
12
However if your offer is determined to be not processable and you have made either the 20%
initial payment for Lump Sum Cash offer, or the first initial installment for the Short Term Periodic
Payment Offer or Deferred Periodic Payment Offer, these payments will not be refunded to you.
They will be applied to your outstanding tax liability and your offer will be returned to you as not
processable.
D. If your offer is determined to be processable and later in the investigation, the offer is returned,
rejected, or withdrawn, the application fee and payments will be applied to your outstanding
tax liability.
E. If you have any additional questions about your Offer in Compromise, application fee or
payments, please call toll free at 1-800-829-1040, visit our web site at www.irs.gov or visit your
nearest IRS office. You will find the exact address in your local phone book under U.S. Govern-
ment.
13
Step Six: Where You Need to Send Your Offer
Where to File IF YOU RESIDE IN

Alaska, Alabama, Arizona, California, Colorado, Hawaii, Idaho, Kentucky, Louisiana,
Mississippi, Montana, Nevada, New Mexico, Oregon, Tennessee, Texas, Utah,
Washington, Wisconsin or Wyoming,
AND AND
You are a wage earner, retiree, or a You are OTHER than a wage earner,
self-employed individual without retiree, or a self-employed individual
employees, without employees,
THEN MAIL THEN MAIL
Form 656 and attachments to: Form 656 and attachments to:
Memphis Internal Revenue Service Memphis Internal Revenue Service

Center COIC Unit Center COIC Unit
PO Box 30803, AMC PO Box 30804, AMC
Memphis, TN 38130-0803 Memphis, TN 38130-0804
IF YOU RESIDE IN
Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois,

Indiana, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota,
Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North
Dakota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina,
South Dakota, Vermont, Virginia, West Virginia or have a foreign address,
AND AND
You are a wage earner, retiree, or a You are OTHER than a wage earner,
self-employed individual without retiree, or a self-employed individual
employees, without employees,
THEN MAIL THEN MAIL
Form 656 and attachments to: Form 656 and attachments to:
Brookhaven Internal Revenue Service Brookhaven Internal Revenue Service
Center COIC Unit Center COIC Unit
PO Box 9007 PO Box 9008
Holtsville, NY 11742-9007 Holtsville, NY 11742-9008
14
Step Seven: What to Expect After the IRS Receives
Your Offer
How We Consider An offer examiner will evaluate your offer return your offer if you do not provide
Your Offer and may request additional documentation the requested information. The examiner
from you to verify financial or other may decide that a larger offer amount is
information you provide. The examiner will necessary to justify acceptance. You will
then make a recommendation to accept or have the opportunity to amend your offer.
reject the offer. The examiner may also
Additional When you submit certain offers, we may ■ Pay a percentage of your future
Agreements also request that you sign an additional earnings.
agreement requiring you to: ■ Waive certain present or future tax
benefits.
Withholding There are certain circumstances where ■ While you appeal an offer rejection.
Collection we will withhold collection activities while
Activities we consider your offer. We will not act to The above do not apply if we find any
collect the tax liability: indication that you submitted your offer to
delay collection or cause a delay which will
■ While we investigate and evaluate your jeopardize our ability to collect the tax.
offer.
■ However, a Notice of Federal Tax
■ For 30 days after we reject an offer. Lien may be filed at any time while
your offer is being considered
Periodic Payments If you choose one of the Periodic Payment the address where you send your periodic
Requirements options, then you are required to continue payments is different from the address
to make payments while your offer is being where you submit your offer form. Be
investigated. The removable Form 656- sure you send your periodic payment and
PPV is to be used to make these periodic Form 656-PPV to the address listed on the
payments. The instructions to complete Form 656-PPV, as it applies to where you
Form 656-PPV are contained on the form originally filed your offer.
as well as the proper address to mail your
payments to. It is important to note that
NOTE: Step Seven continues on Page 16.
15
If We Accept If we accept your offer, we will notify you future compliance provision). If you default
Your Offer by mail. When you receive your acceptance your agreement, we will reinstate the
letter, you must: unpaid amount of the original tax liability,
■ Promptly pay any unpaid amounts file a Notice of Federal Tax Lien on any tax
that become due under the terms of liability without a filed notice, and resume
the offer agreement. You must comply collection activities. The future compliance
with the payment terms specified in the provision applies to all offers based on
agreement in a timely manner or your Doubt as to Collectibility and Effective
offer and agreement will be in default. Tax Administration offers.
■ Comply with all the terms and conditions We will not default your offer agreement
of the offer, along with those of any when you have filed a joint offer with your
additional agreement. spouse or ex-spouse as long as you have
■ Promptly notify us of any change of kept or are keeping all the terms of the
address until you meet the conditions agreement, even if your spouse or ex-
of your offer. Your acceptance letter spouse violates the future compliance
will indicate the IRS office to contact if provision.
your address changes. Your notification
allows us to contact you immediately The offer agreement requires you to
regarding the status of your offer. forego certain refunds, and to return those
refunds to us if they are issued to you by
We will release all Notices of Federal Tax mistake. These conditions are also listed
Lien when you satisfy the payment terms on Form 656, Sections V (f) and (g). For
of the offered amount. For an immediate example, if your offer was accepted by the
release of a lien, you can submit certified IRS in the tax year 2006, the IRS would
funds with a request letter to the address keep the refund due to you with respect
on the acceptance letter. to the tax year 2006, which you would
Once your offer is accepted, not filing normally receive in calendar year 2007
returns or paying taxes when due could (because the due date for filing the tax year
result in the default of an accepted offer 2006 is April 15, 2007).
(see Section V (d) of Form 656 for the
If We Reject Your We will notify you by mail if we reject

Offer your offer. In our letter, we will explain our
reason for the rejection. We will also keep
your $150 application fee and payments.
If your offer is rejected, you have the
right to:
■ Appeal our decision to the Office of
Appeals within thirty days from the
date of our letter. The letter will include
detailed instructions on how
to appeal the rejection.
16
Step Eight: Offer in Compromise Summary Checklist
Below is a checklist of items that you should review and complete prior to submitting
your Form 656, Offer in Compromise. This checklist is solely for your benefit, so do not
submit with your offer.
❏ Did you answer YES to question one ❏ You either attached the
on Page 2? If you did, then please application fee in the designated
do not submit Form 656 because you area on the Form 656 or attached
are not eligible to have your offer the Form 656-A certification,
considered at this time. whichever is applicable. If
you attached Form 656-A, then
❏ Did you answer NO to questions you must complete the Offer in
two or three on Page 2? If you did, Compromise (OIC) Application Fee
then please do not submit Form 656 and Payment Worksheet and attach
because you are not eligible to have it to your offer.
your offer considered at this time.
❏ You have attached to Form 656
❏ Have you properly completed either the 20% payment for the
Form 656, Offer in Compromise, Lump Sum Cash offer, or the first
by following the instructions on installment payment for either the
Pages 10 and 11? Short Term Periodic Payment or
Deferred Periodic Payment, OR
❏ The preprinted terms and conditions attached Form 656-A certification,
listed on Form 656 have not been which ever is applicable. If you
altered or deleted. attached Form 656-A, then you must
❏ Are you using the most current complete the OIC Application Fee
versions of Form 656, Form 433-A, and Payment Worksheet.
and Form 433-B as instructed on ❏ You signed or initialed in all required
Page 4? places on Form 433-A and /or
❏ You included your name (or names, Form 433-B.
if joint). ❏ Your offer amount is greater than
❏ You included your social security or equal to the reasonable collection
number (SSN) (both SSNs are potential (RCP) as described on
required if filing a joint offer) and/or Page 5 and calculated on Page
employer identification number (EIN) 9, unless your offer is based on
and it is accurate. Effective Tax Administration.
❏ You included an offer amount ❏ If applicable, are Sections IX and XI,

(the amount must be greater than on Form 656 completed?
zero) or payment term. ❏ If applicable, is Section X on Form
❏ You signed the Form 656. If this is 656 completed and signed?
a joint Form 656, both spouses must ❏ Have you properly identified where
sign Form 656. to mail your Form 656 from the
❏ You included complete financial instructions on Page 14?
information (Form 433-A or Form
433-B, or both) and all attachments
as instructed on Page 4.
If you have any questions, please call our toll-free number at 1–800–829–1040. You
can get forms and publications by calling toll free at 1–800–829–3676
(1–800–TAX–FORM), or by visiting your local Internal Revenue Service (IRS)
office or our website at www.irs.gov.
17
Important Information Regarding the
Offer in Compromise
Statute of Limitations for Assessment tax liability before submission of this offer.
and Collection is Suspended — The The IRS may keep any proceeds from
statute of limitations for assessment and a levy served prior to submission of the
collection of a tax debt is suspended offer, but not received at the time the offer
while an OIC is “pending,” or being is submitted. If a levy has been served
reviewed. The Offer in Compromise is prior to submission of the offer, or if a levy
pending starting with the date an au- was served after the offer was filed, then
thorized IRS employee determines the immediately contact the IRS person or
Form 656 Offer in Compromise, can be function whose name and phone number
processed and signs the Form 656. The appear on the levy as the contact person.
OIC remains pending until an authorized
IRS employee accepts, rejects, returns, Public Inspection Files for Accepted
or acknowledges withdrawal of the offer Offer in Compromise Files — The law
in writing. If a taxpayer appeals an OIC requires IRS to make certain information
that was rejected, the IRS will continue to from accepted Offers in Compromise
treat the OIC as pending until the Ap- available for public inspection and review.
peals Office accepts or rejects the OIC in These public inspection files are located
writing. in designated IRS Area Offices. It is im-
portant to know that certain information
Taxpayers Must File and Pay Taxes — regarding your accepted Offer in Compro-
In order to avoid defaulting an OIC once mise will be publicly known.
it is accepted by the IRS, taxpayers must
remain in compliance in the filing and Taxpayer Advocate Services — The
payment of all required taxes for a period Taxpayer Advocate Service (TAS) is an
of five years, or until the offered amount independent organization within the IRS
is paid in full, whichever is longer. Failure whose employees assist taxpayers who
to comply with these conditions will result are experiencing harm, who are seeking
in the default of the OIC and the rein- help in resolving tax problems that have
statement of the tax liability. not been resolved through normal chan-
nels, or who believe that an IRS system
Federal Tax Liens Are Not Released — or procedure is not working as it should.
If there is a Notice of Federal Tax Lien on If you believe you are eligible for TAS
record prior to the OIC being submitted, assistance, you can reach TAS by calling
the lien is not released until the terms of the toll free 1-877-777-4778, or
offer in compromise are satisfied, or until TTY/TTD 1-800-829-4059.
the liability is paid, whichever comes first.
Low Income Taxpayer Clinic (LITC) —
The IRS generally files a Notice of Federal Low Income Taxpayer Clinics are
Tax Lien to protect the Government’s inter- independent organizations that provide low
est on all payment offers. This tax lien will income taxpayers with representation in
be released when the payment terms of the Federal tax controversies with the IRS for
offer agreement have been satisfied. free or for a nominal charge. The clinics
also provide tax education and outreach for
Effect of the Offer on the Taxpayer’s taxpayers with limited English proficiency or
Refund — The IRS will keep any refund, who speak English as a second language.
including interest due to the taxpayer be- IRS Publication 4134, Low Income Taxpay-
cause of overpayment of any tax or other er Clinic List, provides information on clinics
liability, for tax periods extending through in your area and is available through the
the calendar year that the IRS accepts IRS website at HYPERLINK “http://www.irs.
the offer. The taxpayer may not desig- gov” www.irs.gov, by phone at
nate an overpayment ordinarily subject to 1-800-TAX-FORM (1-800-829-3676),
refund, to which the IRS is entitled, to be or at your local IRS office.
applied to estimated tax payments for the
following year. Penalties and Interest — Penalites and
interest will continue to accrue on your
Effect of the Offer on Levies — The IRS unpaid balance of assessment(s) while
will keep all payments and credits made, your offer is being considered.
received or applied to the total original
18
Terms and Definitions
An understanding of the following Necessary Expenses — Necessary

terms and conditions will help you to expenses are the allowable payments
prepare offers based upon doubt as you make to support you and your
to collectibility or effective tax family’s health and welfare and/or the
administration. production of income. This expense
does not apply to businesses. See
Current Value — The amount you our web site at www.irs.gov for an
could reasonably expect from the sale explanation of National Standard
of an asset today. Provide an accurate Expenses and the amounts that are
valuation of each asset. Determine allowed. We derive these amounts
value from realtors, used car dealers, from the Bureau of Labor Statistics
publications, furniture dealers, or other Consumer Expenditure Survey. We also
experts on specific types of assets. use information from the Bureau of the
Please include a copy of any written Census to determine local expenses for
estimate with your Collection Information housing, utilities, and transportation.
Statement.
NOTE:
Expenses Not Generally Allowed — If the IRS determines that the
We typically do not allow you to claim facts and circumstances of
tuition for private schools, public or your situation indicate that
private college expenses, charitable using the scheduled allowance
contributions, voluntary retirement of necessary expenses is
contributions, payments on unsecured inadequate, we will allow
debts such as credit card bills, cable you an adequate means for
television charges and other similar providing basic living expenses.
expenses as necessary living expenses. However you must provide
However, we may allow these expenses documentation that using
when you can prove that they are national and local expense
necessary for the health and welfare of standards leaves you an
you or your family or for the production inadequate means of providing
of income. for basic living expenses.
Future Income — We generally Quick Sale Value (QSV) — The amount

determine the amount we could collect you could reasonably expect from the
from your future income by subtracting sale of an asset if you sold it quickly,
necessary living expenses from your typically in ninety days or less. This
monthly income over a set number of amount generally is less than current
months. For a lump sum cash offer value, but may be equal to current value,
paid in five months or less, you must based on local circumstances.
offer what you could pay in monthly
payments over forty-eight months (or Realizable Value — The quick sale
the remainder of the ten-year statutory value amount minus what you owe to a
period for collection, whichever is less). secured creditor. The creditor must have
For a Lump Sum Cash Offer paid in priority over a filed Notice of Federal Tax
more than five months or a Short Term Lien before we allow a subtraction from
Periodic Payment Offer, you must offer the asset’s value.
what you could pay in monthly payments
over 60 months (or the remainder of the Reasonable Collection Potential (RCP)
statutory period for collection, whichever — The total realizable value of your
is less). For a deferred periodic payment assets plus your future income. The total
offer, you must offer what you could is generally your minimum offer amount.
pay in monthly payments during the
remaining time we could legally receive
payments.
19
Department of the Treasury — Internal Revenue Service
Form 656
(February 2007) Offer in Compromise
Attach Application Fee and Payment (check or money order) here.
IRS RECEIVED DATE
Section I Taxpayer Contact Information
Taxpayer's First Name and Middle Initial Last Name
If a joint offer, spouse’s First Name and Middle Initial Last Name
Business Name
Taxpayer's Address (Home or Business) (number, street, and room or suite no., city, state, ZIP code)
Mailing Address (if different from above) (number, street, and room or suite no., city, state, ZIP code)
DATE RETURNED
Social Security Number (SSN) Employer Identification Number (EIN)
(Primary) (Secondary) (EIN included in offer) (EIN not included in offer)
- - - - - -
Section II To: Commissioner of Internal Revenue Service
I/We (includes all types of taxpayers) submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional amounts
required by law (tax liability) for the tax type and period marked below: (Please mark an “X” in the box for the correct description and fill-in the correct tax period(s),
adding additional periods if needed).
1040/1120 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)
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
.
Other Federal Tax(es) [specify type(s) and period(s)]
Note: If you need more space, use a separate sheet of paper and title it “Attachment to Form 656 Dated _________________ .” Sign and date the
attachment following the listing of the tax periods.
Section III Reason for Offer in Compromise
I/We submit this offer for the reason(s) checked below:
Doubt as to Collectibility — “I have insufficient assets and income to pay the full amount.” You must include a complete Collection Information
Statement, Form 433-A and/or Form 433-B.
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.” You must include a complete Collection Information
Statement, Form 433-A and/or Form 433-B and complete Section VI.
Section IV Offer in Compromise Terms

I/We offer to pay $ (must be more than zero). Complete Section VII to explain where you will obtain the funds to make this offer.
Check only one of the following:
Lump sum cash offer – 20% of the amount of the offer $ must be sent with Form 656. Upon written acceptance of the offer, the
balance must be paid in 5 or fewer installments.
$ payable within months after acceptance
Short Term Periodic Payment Offer – Offer amount is paid within 24 months from the date IRS received your offer. The first payment must be
submitted with your Form 656. You must make regular payments during your offer investigation. Complete the following:
$ will be submitted with the Form 656. Beginning in the month after the offer is submitted (insert month ), on the
day of each month, $ will be sent in for a total of months. (Cannot extend more than 24 months from the date
the offer was submitted.)
Catalog Number 16728N www.irs.gov Form 656 (Rev. 2-2007)

Page 2 of 4
Section IV Cont.
Deferred Periodic Payment Offer – Offer amount will be paid over the remaining life of the collection statute. The first payment must be
submitted with your Form 656. You must make regular payments during your offer investigation. Complete the following:
$ will be submitted with the Form 656. Beginning in the month after the offer is submitted (insert month ), on the
day of each month, $ will be sent in for a total of months.
Optional - Designation of Required Payment under IRC 7122(c)
You have the option to designate the required payment you made under Section IV above. If you chose not to designate your required payment, then
the IRS will apply your payment in the best interest of the government. Please complete the following if you choose to designate your payment:
$ paid under IRC 7122 (c) is to be applied to my Tax Year/Quarter(s) (whichever is applicable) for my/our tax
form .
If you pay more than the required payment when you submit your offer and want any part of that additional payment treated as a deposit, check the
box below and insert the amount. It is not required that you designate any portion of your payment as a deposit. Note: If the required payment is not
paid, the offer will be returned even if you make a payment you designate as a deposit.
I am making a deposit of $ with this offer.
Section V By submitting this offer, I/we have read, understand and agree to the following conditions:
(a) I/We voluntarily submit all tax payments made on this (f) The IRS will keep all payments and credits made, received
offer, including the mandatory payments of tax required under or applied to the total original liability before submission of this
section 7122(c). These tax payments are not refundable even offer and all payments required under section 7122(c). The
if I/we withdraw the offer prior to acceptance or the IRS IRS will also keep all payments in excess of those required by
returns or rejects the offer. If the offer is accepted, the IRS will section 7122(c) that are received in connection with the offer
apply payments made after acceptance in the best interest of and that are not designated as deposits in Section IV. The
the government. IRS may keep any proceeds from a levy served prior to
submission of the offer, but not received at the time the offer
(b) Any payments made in connection with this offer will be is submitted. As additional consideration beyond the amount
applied to the tax liability unless I have specified that they be of my/our offer, the IRS will keep any refund, including
treated as a deposit. Only amounts that exceed the interest, due to me/us because of overpayment of any tax or
mandatory payments can be treated as a deposit. Such a other liability, for tax periods extending through the calendar
deposit will be refundable if the offer is rejected or returned by year in which the IRS accepts the offer. The date of
the IRS or is withdrawn. I/we understand that the IRS will not acceptance is the date on the written notice of acceptance
pay interest on any deposit. issued by the IRS to me/us or to my/our representative. I/We
may not designate an overpayment ordinarily subject to
(c) The application fee for this offer will be kept by the IRS refund, to which the IRS is entitled, to be applied to estimated
unless the offer was not accepted for processing. tax payments for the following year.
(d) I/We will comply with all provisions of the Internal Revenue (g) I/We will return to the IRS any refund identified in
Code relating to filing my/our returns and paying my/our paragraph (f) received after submission of this offer.
required taxes for 5 years or until the offered amount is paid in
full, whichever is longer. In the case of a jointly submitted (h) The IRS cannot collect more than the full amount of the
Offer in Compromise joint liabilities, I/we understand that liability under this offer.
default with respect to the compliance provisions described in
this paragraph by one party to this agreement will not result in (i) I/We understand that I/we remain responsible for the full
the default of the entire agreement. The default provisions amount of the liabilities, unless and until the IRS accepts the
described in Section V(i) of this agreement will be applied only offer in writing and I/we have met all the terms and conditions
to the party failing to comply with the requirements of this of the offer. The IRS will not remove the original amount of
paragraph. the liabilities from its records until I/we have met all the terms
and conditions of the offer. I/We understand that the liabilities
(e) I/We waive and agree to the suspension of any statutory I/we offer to compromise are and will remain liabilities until
periods of limitation (time limits provided by law) for the IRS I/we meet all the terms and conditions of this offer. If I/we file
assessment of the liability for the periods identified in Section for bankruptcy before the terms and conditions of this offer
II. I/We understand that I/we have the right not to waive are completed, any claim the IRS files in the bankruptcy
these statutory periods or to limit the waiver to a certain length proceedings will be a tax claim
or to certain periods. I/We understand, however, that the IRS
may not consider this offer if I/we refuse to waive the statutory (j) Once the IRS accepts the offer in writing, I/we have no
periods for assessment or if we provide only a limited waiver. right to contest, in court or otherwise, the amount of the
The amount of any Federal tax due for the periods described liability.
in Section II may be assessed at any time prior to the
acceptance of this offer or within one year of the rejection of (k) The offer is pending starting with the date an authorized
this offer. I/We understand that the statute of limitations for IRS official signs the form. The offer remains pending until an
collection will be suspended during the period an offer is authorized IRS official accepts, rejects, returns or
considered pending by the IRS (paragraph (k) of this section acknowledges withdrawal of the offer in writing. If I/we appeal
defines pending). an IRS rejection decision on the offer, IRS will continue to
treat the offer as pending until the Appeals Office accepts or
rejects the offer in writing.

Page 3 of 4
If I/we don't file a protest within 30 days of the date the IRS (m) The IRS generally files a Notice of Federal Tax Lien to
notifies me/us of the right to protest the decision, I/we waive the protect the Government's interest on offers with deferred
right to a hearing before the Appeals Office about the Offer in payments. Also, the IRS may file a Notice of Federal Tax Lien
Compromise. during the offer investigation. This tax lien will be released
when the payment terms of the offer agreement have been
(l) If I/we fail to meet any of the terms and conditions of the satisfied.
offer and the offer defaults, the IRS may:
(n) I/We understand that IRS employees may contact third
n immediately file suit to collect the entire unpaid balance of parties in order to respond to this request and I/we authorize
the offer; the IRS to make such contacts. Further, by authorizing the IRS
to contact third parties, I/we understand that I/we will not
n immediately file suit to collect an amount equal to the receive notice, pursuant to section 7602(c) of the Internal
original amount of the liability, minus any payment already Revenue Code, of third parties contacted in connection with
received under the terms of this offer; this request.
n disregard the amount of the offer and apply all amounts (o) I/We are offering to compromise all the liabilities assessed
already paid under the offer against the original amount of against me/us as of the date of this offer and under the
the liability; and/or taxpayer identification numbers listed in Section II above. I/We
authorize the IRS to amend Section II, above, to include any
n file suit or levy to collect the original amount of the liability, assessed liabilities we failed to list on Form 656.
without further notice of any kind.
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. The IRS will add interest from
the date the offer is defaulted until I/we completely satisfy the
amount owed.
Section VI Explanation of Circumstances
I am requesting an Offer in Compromise for the reason(s) listed below:

Note: If you believe you have special circumstances affecting your ability to fully pay the amount due, explain your situation. You may attach additional
sheets if necessary. Please include your name and SSN or EIN on all additional sheets or supporting documentation.
Section VII Source of Funds
I / We shall obtain the funds to make this offer from the following source(s):

Page 4 of 4
Section VIII Mandatory Signatures
If I / We submit this offer on a substitute form, I/ we affirm that this form is a verbatim duplicate of the official Form 656,
and I/we agree to be bound by all the terms and conditions set forth in the official Form 656.
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.
Taxpayer Signature of Taxpayer Date

Attestation
Signature of Taxpayer Date
Official Use Only

I accept the waiver of the statutory period of limitations on assessment for the Internal Revenue Service, as described in Section V(e).
Signature of Authorized Internal Revenue Service Official Title Date
Section IX Application Prepared by Someone Other than the Taxpayer
If this application was prepared by someone other than the taxpayer, please fill in that person’s name and address below.
Name
Address (if known) (Street, City, State, ZIP code)
Section X Paid Preparer Use Only
Name of Preparer
Signature of Preparer Date Check if Preparer's CAF no. or PTIN

self-employed
Firm's name (or yours if self-employed), address, and ZIP code EIN
Telephone number
( )
Section XI Third Party Designee
Do you want to allow another person to discuss this offer with the IRS? Yes. Complete the information below. No
Designee's name Telephone number
( )
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 in Compromise. You are not required to make an Offer in
Compromise; 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 X 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.

Offer in Compromise Application Fee and Payment Worksheet
If you answered YES to question one on Page 2, then do not proceed any further. You are not eligible to have
your offer considered at this time.
If you answered NO to question one on Page 2 of this booklet, then you may be eligible to have your offer
considered and you may proceed completing the worksheet. However, it is important that you use the
current version Form 656 (Rev. 02-2007), Offer in Compromise, and the (Rev. 5-2001) versions of Forms 433-
A, Collection Information Statement for Wage Earners and Self-Employed Individuals, and / or 433-B, Collection
Information Statement for Businesses that are included in this package.
The application fee and payment does not apply to individuals whose income falls at or below levels based on IRS Offers
in Compromise Monthly Low Income Guidelines. The exception for taxpayers with incomes below these levels only applies
to individuals; it does not apply to other entities such as corporations or partnerships. If you are self employed, then you
must first look at Section 9, Line 27 of the Form 433A. If you entered a net income from your business, then you may need
to make an adjustment for this item. For the purposes of determining item 2, Total Household Monthly Income, you must
deduct any depreciation of assets that you itemized on your Tax Form 1040 Schedule C, that was used to determine your
net income from your business, line 27. Adjusting line 27 will affect the amount on line 34 of the Form 433A. Therefore line
34 must be adjusted and carried over to this worksheet item 2 for Total Household Monthly Income. If you had no depre-
ciation of assets on Schedule C, then there is no adjustment to be made.
If you are an individual, follow the steps below to determine if you must remit the application fee along with your
Form 656, Offer in Compromise.
1. Family Unit Size_____. Enter the total number of dependants (including yourself and your spouse) listed in Section 1
of Form 433-A, Collection Information Statement for Wage Earners and Self-Employed individuals.
2. Total Household Monthly Income_____________. Enter the amount of your total household monthly income from
Section 9, Line 34 of the Form 433-A, Collection Information Statement for Wage Earners and Self-Employed
Individuals. Please see Page 4 under Step Two, item 5, for a definition of total household income.
3. Compare the information you entered in items 1 and 2, above, to the monthly IRS OIC Monthly Low Income Guide-
lines table below. Find the "Family Unit Size" equal to the number you entered in item 1. Next, find the column which
represents where you reside (48 Contiguous states, DC …, Hawaii or Alaska). Compare the “Total Household Monthly
Income” you entered in item 2 to the number in the row and column that corresponds to your family unit size and
residence. For example, if you reside in one of the 48 contiguous states, and your family unit size from item 1 above is
4, and your total household monthly income from item 2 above is $3000, then you are exempt from the fee and
payment because your income is less than the $4,167 guideline amount.
IRS OIC Monthly Low Income Guidelines

Size of Family Unit 48 Contiguous States and D.C. Hawaii Alaska
1 $2,042 $2,348 $2,552
2 $2,750 $3,163 $3,438
3 $3,458 $3,977 $4,323
4 $4,167 $4,792 $5,208
5 $4,875 $5,606 $6,094
6 $5,583 $6,421 $6,979
7 $6,292 $7,235 $7,865
8 $7,000 $8,050 $8,750
For each additional person, add $708 $815 $885
4. If the total household monthly income you entered in item 2 is more than the amount shown for your family unit size
and residence in the monthly IRS OIC Monthly Low Income Guidelines table above, you must send the $150 appli-
cation fee and any 20% payment or first initial installment with each OIC you submit.
Your check or money order should be made payable to the "United States Treasury" and attached to the front of your
Form 656, Offer In Compromise. Do Not Send Cash. Send a separate application fee with each OIC; do not combine it
with any other tax payments as this may delay processing of your OIC. Your OIC will be returned to you without further
consideration if the application fee and the required payments are not properly remitted, or if your check is returned for
insufficient funds.
5. If the total income you entered in item 2 is equal to or less than the amount shown for your family unit size and residence in
the table above, do not send the application fee or the required payments. Sign and date Form 656-A, Income Certification
for Offer in Compromise Application Fee and Payment. Attach the certification and this worksheet to the front of your
Form 656.
Form 656-A Income Certification for Offer in Compromise

(February 2007) Application Fee and Payment
(For Individual Taxpayers Only)
If you are not required to submit the fee or payments based on your income level, you must complete this form
and attach both it and the worksheet to the front of your Form 656.
Your Name (Last, First, Middle initial) (Please Print) Social Security Number (SSN) or
Taxpayer Identification Number (TIN)
Spouse's Name (Last, First, Middle initial) (Please Print) Social Security Number (SSN) or
Taxpayer Identification Number (TIN)
Certification: I/We certify under penalty of perjury that I am not required to submit an Offer in Compromise application
fee and payment, based on my family unit size and income.
Your Signature Date
Spouse's Signature (if submitting a joint Offer in Compromise) Date
Note: If the Internal Revenue Service determines that you were required to pay a fee or payment, your Offer in
Compromise will be returned without further consideration.
Catalog Number 28300X www.irs.gov Form 656-A (Rev. 2-2007)

Form 656-PPV
(February 2007) Offer in Compromise - Periodic Payment Voucher
If you filed an offer in compromise and the offered amount is to be paid in 24 months or fewer (Short Term Periodic Payment Offer) or monthly
installments paid within the statutory period (Deferred Periodic Payment Offer) in accordance with the Tax Increase Prevention and Reconciliation
Act of 2005, you must continue to make the payments during the investigation of the offer until you receive a decision letter (accepted, rejected,
returned, or withdrawn). Mail this voucher with your check or money order payable to the "United States Treasury." Write your social security number or
employer identification number on the check or money order. Do not send cash. You may designate a specific tax liability to apply the payments. If you
chose to do this, please write it in the "Apply to" section of the 656-PPV.
Enclose your payment with this voucher and mail to:
For those offers originally sent to Holtsville, NY, please send payments to: P.O. Box 9011, Holtsville, NY 11742
For those offers originally sent to Memphis, TN, please send payments to: AMC-Stop 880, PO Box 30834, Memphis, TN 38130-0834
(Please Print or Type)
Taxpayer's First Name and Initial Taxpayer's Last Name Your Social Security Number (SSN) or
Employer Identification Number (EIN)
Taxpayer's Address (number, street, and room or suite no., city, state, ZIP code) Amount of Your Payment
(Dollars) (Cents)
$
Offer Number Apply Payment to: (optional)
Form
Period
Catalog Number 31131Y www.irs.gov Form 656-PPV (2-2007)

Collection Information Statement for Wage Earners
and Self-Employed Individuals
Complete all entry spaces with the most current data available.
Important! Write “N/A” (not applicable) in spaces that do not apply. We may require additional information
www.irs.gov
to support “N/A” entries.
Form 433-A (Rev. 5-2001) Failure to complete all entry spaces may result in rejection or significant delay in the resolution of your account.
Catalog Number 20312N
Section 1 1. Full Name(s) 1a. Home Best Time To Call:

Telephone ( ) am pm
Personal (Enter Hour)
Information Street Address 2. Marital Status:
City State Zip
Married Separated
County of Residence
How long at this address? Unmarried (single, divorced, widowed)
3. Your Social Security No.(SSN) 3a. Your Date of Birth (mm/dd/yyyy)

4. Spouse’s Social Security No. 4a. Spouse’s Date of Birth (mm/dd/yyyy)
5. Own Home Rent Other (specify, i.e. share rent, live with relative)
6. List the dependents you can claim on your tax return: (Attach sheet if more space is needed.)
First Name Relationship Age Does this person First Name Relationship Age Does this person
live with you? live with you?
Check this box No Yes No Yes
when all spaces in
Sect. 1 are filled in. No Yes No Yes
Section 2 7. Are you or your spouse self-employed or operate a business? (Check “Yes” if either applies)
Your No Yes If yes, provide the following information:

Business 7a. Name of Business 7c. Employer Identification No., if available :
Information 7b. Street Address 7d. Do you have employees? No Yes
City State Zip 7e. Do you have accounts/notes receivable? No Yes
Check this box If yes, please complete Section 8 on page 5.
Att
when all spaces in ac
hm
Sect. 2 are filled in en
ts
ATTACHMENTS REQUIRED: Please include proof of self-employment income for the prior 3
and attachments months (e.g., invoices, commissions, sales records, income statement).
provided.
Section 3 8. Your Employer 9. Spouse’s Employer

Street Address Street Address
Employment
Information City State Zip City State Zip
Work telephone no. ( ) Work telephone no. ( )
May we contact you at work? No Yes May we contact you at work? No Yes
8a. How long with this employer? 9a. How long with this employer?
8b. Occupation 9b. Occupation
Check this box
when all spaces in
Att
ac ATTACHMENTS REQUIRED: Please provide proof of gross earnings and deductions for the past
hm
ts 3 months from each employer (e.g., pay stubs, earnings statements). If year-to-date information
and attachments is available, send only 1 such statement as long as a minimum of 3 months is represented.
provided.
Section 4 10. Do you receive income from sources other than your own business or your employer? (Check all that apply.)
Other
Income Pension Social Security Other (specify, i.e. child support, alimony, rental)
Information
Check this box
when all spaces in Att ATTACHMENTS REQUIRED: Please provide proof of pension/social security/other income for the
ac
hm past 3 months from each payor, including any statements showing deductions. If year-to-date
ts
and attachments information is available, send only 1 such statement as long as a minimum of 3 months is
provided. represented.
7
Page 1 of 6
Section 5 begins on page 2 Æ
(Rev. 5-2001)
Collection Information Statement for Wage Earners and Self-Employed Individuals Form 433-A
Name SSN
Section 5 11. CHECKING ACCOUNTS. List all checking accounts. (If you need additional space, attach a separate sheet.)
Banking, Type of Full Name of Bank, Savings & Loan, Bank Bank Current
Account Credit Union or Financial Institution Routing No. Account No. Account Balance
Investment,
Cash, Credit, 11a. Checking Name $
and Life
Street Address
Insurance
Information City/State/Zip
11b. Checking Name $

Complete all
Street Address
entry spaces
City/State/Zip 11c. Total Checking Account Balances $
with the most
current data
available.
12. OTHER ACCOUNTS. List all acounts, including brokerage, savings, and money market, not listed on line 11.
Type of Full Name of Bank, Savings & Loan, Bank Bank Current
12a. Name $
Street Address
City/State/Zip
12b. Name $
Street Address
City/State/Zip 12c. Total Other Account Balances $
Att
ac
hm
en ATTACHMENTS REQUIRED: Please include your current bank statements (checking, savings,
ts
money market, and brokerage accounts) for the past three months for all accounts.
13. INVESTMENTS. List all investment assets below. Include stocks, bonds, mutual funds, stock options, certificates of deposits, and
retirement assets such as IRAs, Keogh, and 401(k) plans. (If you need additional space, attach a separate sheet.)
Number of Current Loan Used as collateral

Name of Company Shares / Units Value Amount on loan?
Current 13a. $ $ No Yes

Value:
Indicate the 13b. No Yes
amount you
could sell the 13c. No Yes
asset for
today.
13d. Total Investments $
14. CASH ON HAND. Include any money that you have that is not in the bank.
14a. Total Cash on Hand $
15. AVAILABLE CREDIT. List all lines of credit, including credit cards.
Full Name of
Credit Institution Credit Limit Amount Owed Available Credit
15a. Name $
Street Address
City/State/Zip
15b. Name $
Street Address
City/State/Zip 15c. Total Credit Available $
16
Page 2 of 6 Section 5 continued on page 3 Æ
(Rev. 5-2001)
Name SSN
Section 5 16. LIFE INSURANCE. Do you have life insurance with a cash value? No Yes
(Term Life insurance does not have a cash value.)
continued
If yes:
16a. Name of Insurance Company
16b. Policy Number(s)
16c. Owner of Policy
16d. Current Cash Value $ 16e. Outstanding Loan Balance $
Subtract “Outstanding Loan Balance“ line 16e from “Current Cash Value” line 16d = 16f $
Check this box
when all spaces in Att
Sect. 5 are filled in ac
hm ATTACHMENTS REQUIRED: Please include a statement from the life insurance companies that
en
and attachments ts includes type and cash/loan value amounts. If currently borrowed against, include loan amount
provided. and date of loan.
Section 6 17. OTHER INFORMATION. Respond to the following questions related to your financial condition: (Attach sheet if you need
more space.)
Other
Information
17a. Are there any garnishments against your wages? No Yes
If yes, who is the creditor? Date creditor obtained judgement Amount of debt $
17b. Are there any judgments against you? No Yes
If yes, who is the creditor? Date creditor obtained judgement Amount of debt $
17c. Are you a party in a lawsuit? No Yes
If yes, amount of suit $ Possible completion date Subject matter of suit
17d. Did you ever file bankruptcy? No Yes
If yes, date filed Date discharged
17e. In the past 10 years did you transfer any
assets out of your name for less than
their actual value? No Yes
If yes, what asset? Value of asset at time of transfer $
When was it transferred? To whom was it transferred?
17f. Do you anticipate any increase in household
income in the next two years? No Yes
If yes, why will the income increase? (Attach sheet if you need more space.)
How much will it increase? $
17g. Are you a beneficiary of a trust or an estate? No Yes

If yes, name of the trust or estate Anticipated amount to be received $
When will the amount be received?
Check this box
when all spaces in 17h. Are you a participant in a profit sharing plan? No Yes
Sect. 6 are filled in.
If yes, name of plan Value in plan $
Section 7 18. PURCHASED AUTOMOBILES, TRUCKS AND OTHER LICENSED ASSETS. Include boats, RV’s, motorcycles, trailers, etc.
Assets and (If you need additional space, attach a separate sheet.)
Amount of
Liabilities Description Current Current
Loan Name of Purchase Monthly
(Year, Make, Model, Mileage) Value Lender Date Payment
Balance
18a. Year
Current Make/Model
Value: Mileage $ $ $
Indicate the
amount you
could sell the 18b. Year
asset for Make/Model
today. Mileage $ $ $
18c. Year
Make/Model
Mileage $ $ $
9
Page 3 of 6 Section 7 continued on page 4Æ
(Rev. 5-2001)
Name SSN
Section 7 19. LEASED AUTOMOBILES, TRUCKS AND OTHER LICENSED ASSETS. Include boats, RV’s, motorcycles, trailers, etc.
(If you need additional space, attach a separate sheet.)
continued
Name and Amount of
Description Lease Address of Lease Monthly
(Year, Make, Model) Balance Lessor Date Payment
19a. Year
Make/Model $ $
19b. Year
Make/Model $ $
Att
ac
hm
en
ATTACHMENTS REQUIRED: Please include your current statement from lender with monthly car
ts
payment amount and current balance of the loan for each vehicle purchased or leased.
20. REAL ESTATE. List all real estate you own. (If you need additional space, attach a separate sheet.)
Amount of ^Date
Street Address, City, Date Purchase Current Loan Name of Lender Monthly of Final
State, Zip, and County Purchased Price Value Balance or Lien Holder Payment Payment
Current 20a.
Value:
Indicate the
amount you
$ $ $ $
could sell the
asset for
today.
20b.
^ Date of
Final Pay- $ $
$ $
ment:
Enter the date
the loan or Att
ac
hm ATTACHMENTS REQUIRED: Please include your current statement from lender with monthly
lease will be en
ts payment amount and current balance for each piece of real estate owned.
fully paid.
21. PERSONAL ASSETS. List all Personal assets below. (If you need additional space, attach separate sheet.)
Furniture/Personal Effects includes the total current market value of your household such as furniture and appliances.
Other Personal Assets includes all artwork, jewelry, collections (coin/gun, etc.), antiques or other assets.
Amount of ^Date of
Current Loan Monthly Final
Description Value Balance Name of Lender Payment Payment
21a. Furniture/Personal Effects $ $ $
Other: (List below)

21b. Artwork $ $ $
21c. Jewelry
21d.
21e.
22. BUSINESS ASSETS. List all business assets and encumbrances below, include Uniform Commercial Code (UCC) filings. (If
you need additional space, attach a separate sheet.) Tools used in Trade or Business includes the basic tools or books used to
conduct your business, excluding automobiles. Other Business Assets includes any other machinery, equipment, inventory or
other assets.
Amount of ^Date of
Current Loan Monthly Final
Description Value Balance Name of Lender Payment Payment
22a. Tools used in Trade/Business $ $ $
Other: (List below)

22b. Machinery $ $ $
Check this box
22c. Equipment
when all spaces in
Sect. 7 are filled in 22d.
and attachments 22e.
provided. 18
Page 4 of 6 Section 8 begins on page 5 Æ
(Rev. 5-2001)
Name SSN
Section 8 23. ACCOUNTS/NOTES RECEIVABLE. List all accounts separately, including contracts awarded, but not
Accounts/ started. (If you need additional space, attach a separate sheet.)
Notes
Receivable
Description Amount Due Date Due Age of Account
0 - 30 days
23a. Name $
Use only if 30 - 60 days
needed. Street Address 60 - 90 days
City/State/Zip 90+ days
Check this
$ 0 - 30 days
box if Section 23b. Name
8 not needed. 30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
23c. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
23d. Name $
30 - 60 days
Street Address 60 - 90 days
0 - 30 days
23e. Name $
30 - 60 days
$ 0 - 30 days
23f. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
23g. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
23h. Name $
30 - 60 days
0 - 30 days
23i. Name $
30 - 60 days
$ 0 - 30 days
23j. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
23k. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
23l. Name $
30 - 60 days
Check this box
when all spaces in Add “Amount Due” from lines 23a through 23l = 23m $
11
(Rev. 5-2001)
Name SSN
Section 9 Total Income Total Living Expenses

Monthly Source Gross Monthly Expense Items 4 Actual Monthly
Income and 24. Wages (Yourself)1 $ 35. Food, Clothing and Misc.5 $
Expense 25. Wages (Spouse)1 36. Housing and Utilities6
Analysis 26. Interest - Dividends 37. Transportation7
27. Net Income from Business2 38. Health Care
If only one 28. Net Rental Income3 39. Taxes (Income and FICA)
spouse has a
tax liability, but 29. Pension/Social Security (Yourself) 40. Court ordered payments
both have 30. Pension/Social Security (Spouse) 41. Child/dependent care
income, list the 31. Child Support 42. Life insurance
total household 32. Alimony 43. Other secured debt
income and
expenses. 33. Other 44. Other expenses
34. Total Income $ 45. Total Living Expenses $
1Wages, salaries, pensions, and social security: Enter your gross monthly wages and/or salaries. Do not deduct withholding
or allotments you elect to take out of your pay, such as insurance payments, credit union deductions, car payments etc.
To calculate your 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 bi-weekly (every 2 weeks) - multiply bi-weekly gross wages by 2.17. Example: $972.45 x 2.17 = $2,110.22
If paid semi-monthly (twice each month) - multiply semi-monthly gross wages by 2. Example: $856.23 x 2 = $1,712.46
2Net Income from Business: Enter your monthly net business income. This is the amount you earn after you pay ordinary and
necessary monthly business expenses. This figure should relate to the yearly net profit from your Form 1040 Schedule C. If it is more
or less than the previous year, you should attach an explanation. If your net business income is a loss, enter “0”. Do not enter a
negative number.
3Net Rental Income: Enter your monthly net rental income. This is the amount you earn after you pay ordinary and necessary
monthly rental expenses. If your net rental income is a loss, enter “0”. Do not enter a negative number.
4 Expenses not generally allowed: We generally do not allow you to claim tuition for private schools, public or private college
expenses, charitable contributions, voluntary retirement contributions, payments on unsecured debts such as credit card bills, cable
television and other similar expenses. However, we may allow these expenses, if you can prove that they are necessary for the
health and welfare of you or your family or for the production of income.
5 Food, Clothing and Misc.: Total of clothing, food, housekeeping supplies and personal care products for one month.
6 Housing and Utilities: For your principal residence: Total of rent or mortgage payment. Add the average monthly expenses for the
following: property taxes, home owner’s or renter’s insurance, maintenance, dues, fees, and utilities. Utilities include gas, electricity,
water, fuel, oil, other fuels, trash collection and telephone.
7 Transportation: Total of lease or purchase payments, vehicle insurance, registration fees, normal maintenance, fuel, public
transportation, parking and tolls for one month.
ATTACHMENTS REQUIRED: Please include:

• A copy of your last Form 1040 with all Schedules.
• Proof of all current expenses that you paid for the past 3 months, including utilities, rent,
Att insurance, property taxes, etc.
ac
hm • Proof of all non-business transportation expenses (e.g., car payments, lease payments,
en
ts fuel, oil, insurance, parking, registration).
• Proof of payments for health care, including health insurance premiums, co-payments,
Check this and other out-of-pocket expenses, for the past 3 months.
box when all
spaces in Sect. 9 • Copies of any court order requiring payment and proof of such payments (e.g., cancelled
are filled in and checks, money orders, earning statements showing such deductions) for the past 3
attachments months.
provided.
Check this box

when all spaces in
all sections are Failure to complete all entry spaces may result in rejection or significant delay in the resolution of your
filled in and all account.
attachments
provided.
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.
Your Signature Spouse’s Signature Date

20
Page 6 of 6 (Rev. 5-2001)
Collection Information Statement for Businesses
Complete all entry spaces with the most current data available.
www.irs.gov Important! Write “N/A” (not applicable) in spaces that do not apply. We may require additional information
to support “N/A” entries.
Form 433-B (Rev. 5-2001)
Catalog Number 16649P Failure to complete all entry spaces may result in rejection or significant delay in the resolution of your account.
Section 1 1a. Business Name 3a. Contact Name

Business Business Street Address 3b. Contact’s Business Telephone ( )
Information Extension
City State Zip Best Time To Call am pm (Enter Hour)
County 3c. Contact’s Home Telephone ( )
1b. Business Telephone ( ) Best Time To Call am pm (Enter Hour)
2a. Employer Identification No. (EIN) 3d. Contact’s Other Telephone ( )
2b. Type of Entity (Check appropriate box below) Telephone Type (i.e. fax, cellular, pager)
Check this box Partnership Corporation Other 3e. Contact’s E-mail Address
when all spaces in
2c. Type of Business
Section 2 4. PERSON RESPONSIBLE FOR DEPOSITING PAYROLL TAXES

Business 4a. Full Name Title Social Security Number | |
Personnel Home Street Address Home Telephone ( )
and City State Zip Ownership Percentage & Shares or Interest
Contacts
5. PARTNERS, OFFICERS, MAJOR SHAREHOLDERS, ETC.
5a. Full Name Title Social Security Number | |
Home Street Address Home Telephone ( )
City State Zip Ownership Percentage & Shares or Interest
5b. Full Name Title Social Security Number | |

5c. Full Name Title Social Security Number | |

5d. Full Name Title Social Security Number | |

Check this box
when all spaces in
Sect. 2 are filled in. City State Zip Ownership Percentage & Shares or Interest
Section 3 6. ACCOUNTS/NOTES RECEIVABLE. List all contracts separately, including contracts awarded, but not started.
Accounts/ Description Amount Due Date Due Age of Account
Notes 0 - 30 days
Receivable 6a. Name $
30 - 60 days
See page 6 City/State/Zip
for additional 90+ days
space, if 0 - 30 days
6b. Name $
needed.
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
6c 90+ days
6a + 6b = 6c $
Amount from 6p
Page 6 +
Check this box 6c + 6p = 6q
when all spaces in 6q. Total Accounts/
Sect. 3 are filled in. Notes Receivable = $
19
(Rev. 5-2001)
Collection Information Statement for Businesses Form 433-B
Business Name EIN
Section 4 7. OTHER FINANCIAL INFORMATION. Respond to the following business financial questions.
Other 7a. Does this business have other business relationships (e.g. subsidiary or parent, corporation, partnership, etc.)? ........... No Yes
Financial
If yes, list related EIN __________________________ Additional EIN ___________________________
Information
7b. Does anyone (e.g. officer, stockholder, partner or employees) have an outstanding loan borrowed from the business? ........... No Yes
If yes, amount of loan $ _________________ Date of loan ________________ Current balance $_______________
7c. Are there any judgments or liens against your business? .................................................................................................... No Yes
If yes, who is the creditor?___________ Date creditor obtained judgment/lien _________ Amount of debt $ ______________
7d. Is your business a party in a lawsuit? ...................................................................................................................................

No Yes
If yes, amount of suit $ _____________ Possible completion date ______________ Subject matter of suit________________
7e. Has your business ever filed bankruptcy? ............................................................................................................................. No Yes

If yes, date filed ___________________ Date discharged ____________________ Petition No.______________________
7f. In the past 10 years have you transferred any assets from your business name for less than their actual value? ............. No Yes
If yes, what asset? _______________________________ Value of asset at time of transfer $_________________________
When was it transferred? ________________ To whom or where was it transferred?________________________________
7g. Do you anticipate any increase in business income (e.g. contracts bid but not yet awarded)? .......................................... No Yes
If yes, why will the income increase? ____________________________________ ..... (Attach sheet if you need additional space.)
How much will it increase? _______________________ When will the business income increase?_____________________
7h. Is your business a beneficiary of a trust, an estate or a life insurance policy? .................................................................... No Yes
Check this box
when all spaces in If yes, name of the trust, estate or policy? _____________________ Anticipated amount to be received?________________
Sect. 4 are filled in. When will the amount be received?_____________________
Section 5 8. PURCHASED AUTOMOBILES, TRUCKS AND OTHER LICENSED ASSETS. Include boats, RV’s, motorcycles, trailers, etc.
Business Amount of
Assets Description Current Loan Name of Purchase Monthly
(Year, Make, Model, Mileage) Value Balance Lender Date Payment
Current Year
Value: 8a.
Indicate the Make/Model
amount you Mileage $ $ $
could sell the
asset for today.
8b. Year
Make/Model
Mileage $ $ $
8c. Year
Make/Model
Mileage $ $ $
9. LEASED AUTOMOBILES, TRUCKS AND OTHER LICENSED ASSETS. Include boats, RV’s, motorcycles, trailers, etc.
Amount of
Description Lease Name Lease Monthly
(Year, Make, Model) Balance of Lessor Date Payment
9a. Year
Make/Model $ $
9b. Year
Make/Model $ $
Attac
hme ATTACHMENTS REQUIRED: Please include your current statement from lender with monthly
nts car payment amount and current balance of the loan for each vehicle purchased or leased.
32
(Rev. 5-2001)
Business Name EIN
Section 5 10. REAL ESTATE. List all real estate owned by the business. (If you need additional space, attach a separate sheet.)
Amount of ^Date
continued Street Address, City, Date Purchase Current Loan Name of Lender Monthly of Final
State, Zip, and County Purchased Price Value Balance or Lien Holder Payment Payment
Current 10a.
Value:
Indicate the
amount you $ $ $ $
could sell the
asset for today.
^Date of Final 10b.

Payment:
Enter the date
the loan or $ $ $ $
lease will be
fully paid.
Attac
hme ATTACHMENTS REQUIRED: Please include your current statement from lender with monthly
nts payment amount and current balance for each piece of real estate owned.
Check this 11. BUSINESS ASSETS. List all business assets and encumbrances below, include Uniform Commercial Code (UCC) filings. (If you
need additional space, attach a separate sheet.) Note: If attaching a depreciation schedule, the attachment must include
box if you are
all of the information requested below.
attaching a Amount of ^Date
depreciation Current Loan Monthly of Final
schedule for Description Value Balance Name of Lender Payment Payment
machinery/ 11a. Machinery $ $ $
equipment in
lieu of
completing
line 11.
Equipment
Merchandise
Other Assets: (List below)
11b. $ $ $
11c.
Check this box

when all spaces in Attac
hme
ATTACHMENTS REQUIRED: Please include your current statement from lender with monthly
Sect. 5 are filled in nts payment amount and current loan balance for assets listed which have an encumbrance.
and attachments
provided.
Section 6 12. INVESTMENTS. List all investment assets below. Include stocks, bonds, mutual funds, stock options and certificates of deposits.
Investment, Number of Current Loan Used as collateral
Banking and Name of Company Shares / Units Value Amount on loan?
Cash
$ $ No Yes
Information 12a.
12b. No Yes
12c. Total Investments $
21
(Rev. 5-2001)
Business Name EIN
Section 6 13. BANK ACCOUNTS. List all checking and savings accounts. (If you need additional space, attach a separate sheet.)
continued Type of Full Name of Bank, Savings & Loan, Bank Bank Current
Complete all
13a. Checking Name $
entry spaces
with the most Street Address
current data City/State/Zip
available.
13b. Checking Name $
Street Address
City/State/Zip
13c. Savings Name $
Street Address
City/State/Zip 13d. Total Bank Account Balances $
Attac
hme
ATTACHMENTS REQUIRED: Please include your current bank statements (checking and
nts savings) for the past three months for all accounts.
14. OTHER ACCOUNTS. List all accounts including brokerage accounts, money market, additional checking and savings accounts
not listed on line #13 and any other accounts not listed in this section.
Type of Full Name of Bank, Savings & Loan, Bank Bank Current
14a. Name $
Street Address
City/State/Zip
14b. Name $
Street Address
City/State/Zip 14c. Total Other Account Balances $
Attac
hme ATTACHMENTS REQUIRED: Please include your current bank statements (checking, savings,
nts money market, and brokerage accounts) for the past three months for all accounts.
15. CASH ON HAND. Include any money that you have that is not in the bank.
15a. Total Cash on Hand $
16. AVAILABLE CREDIT. List all lines of credit, including credit cards.
Full Name of
Credit Institution Credit Limit Amount Owed Available Credit
16a. Name $
Street Address
City/State/Zip
Check this box 16b. Name $

when all spaces in
Sect. 6 are filled in Street Address
and attachments
provided. City/State/Zip 16c. Total Credit Available $
34
(Rev. 5-2001)
Business Name EIN
Section 7 17. The following information applies to income and expenses from your most recently filed Form 1120 or Form 1065.
Fiscal Year Period to
Monthly
Income and 18. Accounting Method Used: Cash Accrual
Expenses
Complete all
entry spaces The information included on lines 19 through 39 should reconcile to your business federal tax return.
with the most Total Income Total Expenses
current data Source Gross Monthly Expense Items Actual Monthly
available. 19. Gross Receipts $ 27. Materials Purchased 1 $
20. Gross Rental Income 28. Inventory Purchased 2
21. Interest 29. Gross Wages & Salaries
22. Dividends 30. Rent
Other Income (specify in lines 23-25) 31. Supplies 3
23. 32. Utilities / Telephone 4
24. 33. Vehicle Gasoline / Oil
25. 34. Repairs & Maintenance
(Add lines 19 through 25) 35. Insurance
26. TOTAL INCOME $ 36. Current Taxes 5
Other Expenses
(include installment payments, specify in lines 37-38)
37.
38.
(Add lines 27 through 38)
39. TOTAL EXPENSES $
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 your business that are consumed or used up within one year, this could be the
cost of books, office supplies, professional instruments, etc.
4 Utilities: Utilities include gas, electricity, water, fuel, oil, other fuels, trash collection and telephone.
Check this box 5 Current Taxes: Real estate, state and local income tax, excise, franchise, occupational, personal property, sales and the
when all spaces in employer’s portion of employment taxes.
Check this box

when all spaces in Failure to complete all entry spaces may result in rejection or significant delay in the resolution of your account.
all sections are
filled in and all
attachments
provided.
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.
Print Name Title
Your Signature Date
23
Page 5 of 6
Accounts/Notes Receivable Continuation on page 6 Æ
(Rev. 5-2001)
Business Name EIN
Section 3 ACCOUNTS/NOTES RECEIVABLE CONTINUATION PAGE. List all contracts separately, including contracts awarded, but not
Accounts/ started. (If you need additional space, copy this page and attach to the 433-B package.)
Notes
Receivable Description Amount Due Date Due Age of Account
continued 0 - 30 days
6d. Name $
30 - 60 days
Use only if Street Address 60 - 90 days
needed. City/State/Zip 90+ days
Check this $ 0 - 30 days

6e. Name
box if this 30 - 60 days
page is not Street Address
60 - 90 days
needed. City/State/Zip
90+ days
$ 0 - 30 days
6f. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
6g. Name $
30 - 60 days
$ 0 - 30 days
6h. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
6i. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
6j. Name $
30 - 60 days
$ 0 - 30 days
6k. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
6l. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
0 - 30 days
6m. Name $
30 - 60 days
$ 0 - 30 days
6n. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
$ 0 - 30 days
6o. Name
30 - 60 days
Street Address
60 - 90 days
City/State/Zip
90+ days
Check this box
when all spaces in (Add this amount to amount
Sect. 3 are filled in. Add lines 6d through 6o = 6p $ on line 6c, Section 3, page 1)
36
Page 6 of 6
(Rev. 5-2001)

Offer in Compromise: Form 656

Uploaded by

Offer in Compromise: Form 656

Uploaded by

IRS

Department of the Treasury

Form 656 (Rev. 02-2007)

An Offer in Compromise (OIC) is an the taxpayer owes part or all of the

Doubt as to Collectibility may include factors such as advanced

Please see Pages 8 and 9.

Funding Your Offer

If you do not have the cash to pay your

1. Enter total checking account balances from Item 11c A

Form 433-A. If less than 0 , enter 0

3. Enter total investments from Item 13d C

4. Enter total cash on hand from Item 14a D

5. Enter life insurance cash value from Item 16f E

6. Enter total accounts/notes receivable from Item 23m F

7. Purchased Automobiles, Trucks, and Other Licensed Assets Individual

From line 21a $ x .8 = $ —$ =

10. Business Assets Individual

From line 22b $ x .8 = $ —$ =

From line 22a $ x .8 = $ —$ =

12. Enter amount from Item 34 $

Enter amount Enter amount

Enter amount Enter amount

Section VII: Explain where you will get the funds to

Two people Two people

Each will One with

Where to File IF YOU RESIDE IN

THEN MAIL THEN MAIL

Memphis Internal Revenue Service Memphis Internal Revenue Service

Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois,

THEN MAIL THEN MAIL

NOTE: Step Seven continues on Page 16.

If We Reject Your We will notify you by mail if we reject

❏ You included an offer amount ❏ If applicable, are Sections IX and XI,

An understanding of the following Necessary Expenses ­— Necessary

Future Income — We generally Quick Sale Value (QSV) — The amount

1040/1120 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)

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

Section IV Offer in Compromise Terms

Catalog Number 16728N www.irs.gov Form 656 (Rev. 2-2007)

Catalog Number 16728N www.irs.gov Form 656 (Rev. 2-2007)

The IRS will continue to add interest, as section 6601 of the

Section VI Explanation of Circumstances

I am requesting an Offer in Compromise for the reason(s) listed below:

Section VII Source of Funds

Catalog Number 16728N www.irs.gov Form 656 (Rev. 2-2007)

Section VIII Mandatory Signatures

Taxpayer Signature of Taxpayer Date

Signature of Taxpayer Date

Official Use Only

Section IX Application Prepared by Someone Other than the Taxpayer

Address (if known) (Street, City, State, ZIP code)

Section X Paid Preparer Use Only

Signature of Preparer Date Check if Preparer's CAF no. or PTIN

Section XI Third Party Designee

Privacy Act Statement

Catalog Number 16728N www.irs.gov Form 656 (Rev. 2-2007)

IRS OIC Monthly Low Income Guidelines

Form 656-A Income Certification for Offer in Compromise

Your Signature Date

Spouse's Signature (if submitting a joint Offer in Compromise) Date

Catalog Number 28300X www.irs.gov Form 656-A (Rev. 2-2007)

Enclose your payment with this voucher and mail to:

(Please Print or Type)

Catalog Number 31131Y www.irs.gov Form 656-PPV (2-2007)

Section 1 1. Full Name(s) 1a. Home Best Time To Call:

3. Your Social Security No.(SSN) 3a. Your Date of Birth (mm/dd/yyyy)

Your No Yes If yes, provide the following information:

Section 3 8. Your Employer 9. Spouse’s Employer

11b. Checking Name $

Number of Current Loan Used as collateral

 Current 13a. $ $ No Yes

14a. Total Cash on Hand $

17g. Are you a beneficiary of a trust or an estate? No Yes

21a. Furniture/Personal Effects $ $ $

An understanding of the following Necessary Expenses — Necessary

Number of Current Loan Used as collateral

Current 13a. $ $ No Yes

Your Signature Spouse’s Signature Date

Your Signature Date