Department of the Treasury — Internal Revenue Service 
Form 14135            Application for Certificate of Discharge of                                               OMB No. 1545-2174
(June 2010) 
                                   Property from Federal Tax Lien 
Complete the entire application.  Enter NA (not applicable), when appropriate.  Attachments and exhibits should be 
included as necessary.  Additional information may be requested of you or a third party to clarify the details of the 
transaction(s). 

1. Taxpayer Information (Individual or Business named on the notice of lien): 
Name (Individual First, Middle Initial, Last) or (Business) as it appears on lien          Primary Social Security Number 
                                                                                           (last 4 digits only) 

Name Continuation (Individual First, Middle Initial, Last) or (Business d/b/a)             Secondary Social Security Number 
                                                                                           (last 4 digits only) 

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

City                                             State                                     ZIP Code 

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

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

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

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

City                                             State                                     ZIP Code 

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

3. Purchase/Transferee/New Owner                                                  Check if also the Applicant 
                                                                                  Relationship to taxpayer 

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

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

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

City                                             State                                     ZIP Code 

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

5. Lender/Finance Company Information - or (Settlement/Escrow Company for applications under Section 6325(b)(3) only) 

Company Name                                     Contact Name                              Contact Phone Number 

Catalog Number 54727S                                        www.irs.gov                            Form 14135 (Rev. 06-2010) 

                                                                                                                   Page 2 of 3 
6.  Monetary Information 

Proposed sales price 

Expected proceeds to be paid to the United States in exchange for 
the certificate of discharge (Enter NA if no proceeds are anticipated) 
7.  Basis for Discharge: Check the box below that best addresses what you would like the United States to consider in 
your application for discharge.    (Publication 783 has additional descriptions of the Internal Revenue Code sections listed below.) 
6325(b)(1)            Value of property remaining attached by the lien(s) is at least double the liability of the federal tax 
                      lien(s) plus other encumbrances senior to the lien(s) 
6325(b)(2)(A)  The United States receives an amount not less than the value of the United States' interest. 
                      (Note: If you are applying under 6325(b)(2)(A) and are the property owner but not the taxpayer, see also 
                      section 16.) 

6325(b)(2)(B)  Interest of the United States in the property to be discharged has no value. 
6325(b)(3)            Proceeds from property sale held in escrow subject to the liens and claims of the United States. 
6325(b)(4)            Deposit made or bond furnished in an amount equal to the value of the United States' interest. 
                      (Note: This selection provides a remedy under 7426(a)(4) for return of deposit but is exclusively for a property 
                      owner not named as the taxpayer on the lien) 
8.  Description of property (for example, 3 bedroom rental house;  2002 Cessna twin engine airplane, serial number 
AT919000000000X00; etc.): 

Address of real property (If this is personal property, list the address where the property is located): 
Address (Number, Street, P.O. Box) 

City                                                 State                  ZIP Code 

FOR REAL ESTATE:         a legible copy of the deed or title showing 
the legal description is required                                           Attached NA 
FOR Discharge Requests under Section 6325(b)(1): 
copy of deed(s) or title(s) for property remaining subject to the           Attached NA 
Federal Tax Lien is required 
9.  Appraisal and Valuations 
REQUIRED APPRAISAL 
                                                                            Attached 
Professional appraisal completed by a disinterested third party 
PLUS ONE OF THE FOLLOWING ADDITIONAL VALUATIONS: 

County valuation of property (real property)                                Attached 
Informal valuation of property by disinterested third party                 Attached 
Proposed selling price (for property being sold at auction)                 Attached 
Other:                                                                      Attached 
AND for applications under Section 6325(b)(1), valuation information (of the type described above in this section) must also be 
provided for property remaining subject to the lien. 
Catalog Number 54727S                                       www.irs.gov              Form 14135 (Rev. 06-2010) 

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10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ) 
                                                                                                        Attached   No 
OR list the lien number(s) found near the top right corner on the lien document(s) (if known) 

11. Copy of the sales contract/purchase agreement (if available)                                        Attached   No 
OR 
Describe how and when the taxpayer will be divested of his/her interest in the property: 

12. Copy of a current title report                                                                      Attached   No 
OR 
List encumbrances senior to the Federal Tax Lien.  Include name and address of holder; description of encumbrance, 
e.g., mortgage, state lien, etc.; date of agreement; original loan amount and interest rate; amount due at time of 
application; and family relationship, if applicable (Attach additional sheets as needed): 

13. Copy of proposed closing statement (aka HUD-1)                                                      Attached   No 
OR 
Itemize all proposed costs, commissions, and expenses of any transfer or sale associated with property (Attach 
additional sheets as needed): 

14. Additional information that may have a bearing on this request, such as pending                     Attached   No 
litigation, explanations of unusual situations, etc., is attached for consideration 
15. Escrow Agreement (For applications under IRC 6325(b)(3)) 
                                                                                                        Attached   No 
Escrow agreement must specify type of account, name and depositary for account, 
conditions under which payment will be made, cost of escrow, name and address of any 
party identified as part of escrow agreement, and signatures of all parties involved including 
Advisory Group Manager.  Terms for agreement must be reached before discharge approved. 
16. WAIVER (For applications made by third parties under IRC 6325(b)(2)) 
If you are applying as an owner of the property and you are not the taxpayer, to have this application considered under section 
6325(b)(2), you must waive the rights that would be available if the application were made under section 6325(b)(4). If you choose 
not to waive these rights, the application will be treated as one made under 6325(b)(4) and any payment will be treated like a 
deposit under that section. Please check the appropriate box. 
I understand that an application and payment made under section 6325(b)(2) does not provide the judicial remedy 
available under section 7426(a)(4). In making such an application / payment, I waive the option to have the payment 
treated as a deposit under section 6325(b)(4) and the right to request a return of funds and to bring an action under 
section 7426(a)(4). 
                                                                                                             Waive No 
17. Declaration 
Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules, exhibits, 
affidavits, and statements and to the best of my knowledge and belief it is true, correct and complete. 

                                Signature/Title                                                         Date 

                                   Signature/Title                                                      Date 

Catalog Number 54727S                               www.irs.gov                                         Form 14135 (Rev. 06-2010)