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FORM CM-1                                  STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 2022)
                                           OFFER IN COMPROMISE
                                                                                                                             CM1_I 2022A 01 VID01
Attach your check or money order payable to the "Hawaii State Tax Collector" here.
Section 1                                        Your Contact Information
Your first name, middle initial, last name                                                        Your social security number

If this is a joint offer, spouse’s first name, middle initial, last name                          Your spouse’s social security number

Your mailing address (number and street)

City or town, state, and postal/ZIP code                                                          Your telephone number

Business name                                                                                     Federal employer identification number

Your business mailing address (number and street)

City or town, state, and postal/ZIP code                                                          Business telephone number

Name of your representative (attach Form N-848)                                                   Your representative's telephone number

Section 2                                        Proposed Tax Amounts
To:  Director of Taxation
In the following agreement, the pronoun “we” may be assumed in place of “I” when there are joint liabilities and 
both parties have signed this agreement.
I submit this offer to compromise the tax liabilities including interest, penalties, additions to tax, and additional 
amounts required by law for the tax type(s) and period(s) listed below:
Type of Tax              Period                  Amount of Tax           Amount of Penalty        Amount of Interest         Total Amount

If you need more space, attach another sheet of paper titled “Attachment to Form CM-1 dated_____.”
Section 3                                        Reason for Offer (Select one reason)
         Doubt as to Collectability - I have insufficient assets and income to pay the full amount.
          Doubt as to Liability - I have a legitimate reason that I do not owe part or all of the tax debt. I am submitting a 
         written narrative with this offer to explain my circumstances.
          Exceptional Circumstances (Effective Tax Administration) - I owe this amount and have sufficient assets to pay 
          the full amount, but due to my exceptional circumstances, requiring full payment would cause an economic 
         hardship or would be unfair and inequitable. I am submitting a written narrative with this offer to explain my 
          circumstances.

                                                                                                                             FORM CM-1
                                                 ID NO 01

FORM CM-1 (REV. 2022)                                                                                                  PAGE 2

Section 3 (Continued)                                 Reason for Offer 
Explanation of Circumstances (Attach additional pages, if needed)
The Department of Taxation understands that there are unplanned events or special circumstances, such as serious ill-
ness, where paying the full amount or the minimum offer amount might impair your ability to provide for yourself and your 
family. If this is the case and you can provide documentation to prove your situation, then your offer may be accepted 
despite your financial profile. Describe your situation below and attach your supporting documentation to this form.

Section 4                           Low-Income Certification (Individuals Only)
Do you qualify for low-income certification? You qualify if your gross monthly household income is less than or equal to 
the low-income certification guidelines published by the Internal Revenue Service (IRS) at the time your offer is submitted 
to the Department of Taxation.
 Check here if you qualify for low-income certification based on the monthly income guidelines printed on federal 
  Form 656. Then enter your information in the spaces below.
  Size of your family unit          State you live in Your monthly income                             IRS monthly income guideline

Section 5                                 Offer Amount and Payment Terms
Select option A (lump-sum offer in compromise) or option B (periodic payment offer in compromise) and complete the  
section for your offer type. Your offer must be accompanied with a minimum initial payment as indicated below. If you do 
not submit the minimum initial payment with your offer, then your offer will be rejected. The minimum initial payment will 
be waived for individuals who apply for and meet the low-income certification requirements in section 4.
  Option A. Lump-Sum Offer in Compromise - I am offering to pay in five or fewer monthly installments. Your offer 
 must include a minimum initial payment of at least 20% of your total offer amount unless you meet the low-income 
  certification requirements. Installment #1 must be made no later than 30 days after the date of acceptance.
  Total Offer Amount                          Initial Payment Submitted with Offer                    Remaining Balance
                                    –                                              =

  Installment #1           Installment #2             Installment #3               Installment #4      Installment #5
  Installment Amount       Installment Amount         Installment Amount           Installment Amount  Installment Amount 
$                    $                        $                          $                            $

  Option B. Periodic Payment Offer in Compromise - I am offering to pay in six or more monthly installments.  
 Your offer must include a minimum initial payment of one monthly installment unless you meet the low-income 
  certification requirements. Your offer must be fully paid within 24 months from the date your offer is accepted.
  Total Offer Amount                          Initial Payment Submitted with Offer                    Remaining Balance
                                    –                                              =
  Monthly Installment Amount                          Number of Payments                               Total 
$                                   x                                              =

I agree to pay monthly installments by the _____ day of each month beginning on ___________ (mm/dd/yy) until the total 
amount of the offer is paid in full.

                                                                                                             FORM CM-1

FORM CM-1 (REV. 2022)                                                                                         PAGE 3

Section 6                                            Offer Terms
By submitting this offer, I/we have read, understand and agree to the following terms and conditions:
1.  I request that the Department of Taxation (Department) accept the offer amount listed in this offer application as 
  payment of my outstanding tax debt (including interest, penalties, and additions to tax) as of the date listed on this 
  form. I authorize the Department to amend Section 2 on page 1 in the event that I failed to list or incorrectly listed any 
  of my assessed tax debt.
2.  I voluntarily submit the payments made on this offer and understand that they are not refundable even if I withdraw 
  the offer or the Department rejects or returns the offer. The Department will keep all payments and other credits it has 
  collected prior to this offer and any payments that I make relating to this offer.
3.  I understand that the Department will keep all payments, credits, refunds, including interest, that I might be due for 
  tax periods extending through the calendar year in which the Department accepts my offer. I cannot designate that 
  these amounts be applied to estimated tax payments for the following year or the accepted offer amount. If I receive a 
  refund after I submit this offer for any tax period extending through the calendar year in which the Department accepts 
  my offer, I will return the refund immediately to the Director of Taxation (Director). 
4.  The payments and all other amounts kept by the Department shall be applied to my tax debt in the best interest of the 
  State and in a manner consistent with section 231-27, Hawaii Revised Statutes.
5.  If I fail to meet any of the terms of this offer, the Department may take collection actions against me without further 
  notice. These actions may include, but are not limited to levying my property, filing a civil suit against me, garnishing 
  my wages, and referral to a private collection agency. The Department will attempt to collect any amount ranging from 
  the unpaid balance of the offer to the original amount of the tax debt, interest on the unpaid balance at the rate of 8 
  percent per year, and cost recovery fees. If I fail to meet any terms of this offer, I waive the right to contest, in court or 
  otherwise, the amount of the tax debt.
6.  I understand that my offer does not relieve me of the tax liabilities (including interest, penalties, and additions to tax) 
  listed in this offer unless and until it is actually accepted in writing by the Director or the Director's authorized repre-
  sentative, approved by the Governor (where applicable), and the terms of the offer have been satisfied. Once the 
  Department accepts my offer in writing, I waive all rights to contest, in court or otherwise, the amount of the tax debt.
Section 7                                      ADDITIONAL REQUIREMENTS
Failure to provide required documents will result in summary rejection of the offer in compromise. 
Complete and submit the following:
… Form CM-1 Offer in Compromise
… Form CM-2 (Individual) or CM-2B (Corporation) Statement of Financial Condition (Federal forms are acceptable)
… Copies of all bank statements, bank checks, check register for last three months

If applicable, provide copies of the following:

… Statements showing premium amounts for all insurance (auto, home, health, renters, etc.). Coverage page of home-
  owners and renters insurance policies and the first page of all insurance policies
… Federal Income tax returns for the last 3 tax years
… Any and all contracts and notes receivables
… All judgments, including divorces
… Real property: Name and address of encumbrance/lien holder and proof of remaining balance. Your interest in all 
  deeds to real property. Realtor's valuation and current year's county assessor's valuation. If renting, provide rent or 
  lease agreement
… Vehicles: Registration certificate(s) issued by the Department of Licensing, verification encumbrances against all 
  vehicles and current statements. Verification on the determined values, including cars, boats, trucks, motor homes, 
  airplanes, etc.
… Pre or ante nuptial agreement, affidavits from parties under penalty of perjury adherence to said agreements
… Trust that you are the beneficiary or have an interest
… Pay check statement last six months
                                                                                                     FORM CM-1

FORM CM-1 (REV. 2022)                                                                                             PAGE 4

… Court ordered payments (child/spousal support, fines, etc.)
… Monthly expenses not already covered (utility bills, transportation, etc.)
…  Doctors papers if claiming ill health or disabled

… Source of funds for offer
… Federal Offer in Compromise and letter of acceptance
Section 8                  Signature of Taxpayer(s)
If this is a joint offer, then both spouses must sign the form. If signed by a corporate officer, partner, limited liability com-
pany member, guardian, tax matters partner/person, executor, receiver, administrator, or trustee on behalf of the taxpayer, 
I certify that I have the authority to execute this form on behalf of the taxpayer. I declare that this offer (including any ac-
companying schedules or statements) has been examined by me and, to the best of my knowledge and belief, it is true, 
correct, and complete.
†
  Signature                                           Title                         Date

  Print name                                          Print taxpayer's name if the taxpayer is not an individual
†
  Signature                                           Title                         Date

  Print name

Section 9                  Paid Preparer Use Only 
Preparer's                                            Date
                                                                                    Check if self-employed
signature                                                                                                         …
Print preparer's                                      Preparer's identification no. Federal employer identification number
name
Firm's name (or yours 
if self-employed), 
address and ZIP Code