Enlarge image | Arizona Department of Revenue • Field Collections P O Box 29021 • Phoenix, AZ 85038-9021 • (602) 716-7787 Email: oicprocessing@azdor.gov www.azdor.gov OFFER-IN-COMPROMISE This booklet contains: • Requirements for submitting an Offer-in-Compromise • Instructions for completing an Offer-in-Compromise • Statement of Offer form • Other important information • Checklist for additional information OTHER LOCATION Tucson Government Mall • 400 West Congress • Tucson ADOR 11005 (8/18) Offer-in-Compromise Page 1 of 6 |
Enlarge image | What we can compromise State your reason for making the offer. All offers must meet the criteria as set forth in Indicate any liability you have with the Internal Arizona Revised Statutes (ARS) §42‑1004.B. The Revenue Service (IRS) and the current status of the liability must be determined to be uncollectible or account. the administrative costs of collection must exceed the amount of the liability. Make sure that all responsible parties sign the Statement of Offer. These may include your spouse, partner, or Requirements for submitting an offer other corporate officer(s). You must be in full reporting compliance for any offer Complete required financial statements. You may be to be considered. All income tax returns for the last required to complete both a business and personal three (3) years must be filed. If you are operating a financial statement. business, all business tax filings and licenses must also be current. Provide any additional information listed on the checklist which pertains to your offer. Failure to When you sign and submit an offer, you agree to the provide any of the information on the checklist may waiver and suspension of any statutory periods of cause a delay in the processing of your offer. limitations for assessment and collections of the tax liability while the offer‑in‑compromise is pending, You may also submit any other information that you during the time the offered amount remains unpaid and feel may pertain to your offer. for one (1) year after the satisfaction of the terms of the offer‑in‑compromise. This includes, but is not limited to, the provision provided for in ARS §42‑1105.D. Instructions for completing an Offer-in-Compromise Before completing the Statement of Offer form, review all information in the Offer-in-Compromise booklet along with the financial statement(s). Missing or incomplete information may cause a delay in processing your offer. Complete each item on the Statement of Offer form. Verify that all names, addresses, and identifying numbers are complete and accurate. Enter the balance due. If you need to obtain your balance(s), you may call (602) 716‑7787 and ask to speak to the Officer of the Day or your assigned Revenue Officer. Enter the amount of your offer. An offer made with no specified dollar amount will not be considered. Indicate how the amount offered will be paid and the source of funds for your offer. ADOR 11005 (8/18) Offer-in-Compromise Page 2 of 6 |
Enlarge image | Statement of Offer within 30 days of receiving notice, this agreement may be considered in default. TERMS AND CONDITIONS I/We agree to the waiver and suspension of any statutory period(s) of limitations for assessment and/or collection of the aforementioned The amount offered on the front of this form is offered in lieu of liability while the offer‑in‑compromise is pending and until the aforementioned liability. I/We acknowledge the liability is the offered amount is paid in full. The offer‑in‑compromise is due and owed to the Arizona Department of Revenue (hereinafter pending from the date the statement of offer form is received by called “department”). I/We request that the department abate the department and until an authorized official of the department the remaining balance due pursuant to ARS §42‑1004.B. By formally, in writing, accepts or rejects the offer‑in‑compromise submitting this offer‑in‑compromise, I/we have read, understand request. and agree to the following terms and conditions. I/We voluntarily submit all payments on this offer. The department will apply I/We represent that all information relating to my/our financial payments made under this offer at its discretion. condition has been fully disclosed. If at any time the department becomes aware that I/we did not provide full disclosure, the This offer is not an admission by the State of Arizona (hereinafter department retains the right to void this offer‑in‑compromise called “the state”) and/or the department as to any fact. Neither without further notice, taking actions necessary to collect the does this offer‑in‑compromise imply any department policy with entire balance due on the liability. Debtor(s) authorize(s) the respect to the taxability or nontaxability of any activity under any State of Arizona to obtain relevant credit bureau report(s) as tax type. needed for any purpose in connection with my(our) account(s) Once the department accepts or rejects the offer in writing, I/we with the state. The state is authorized to pull the taxpayer’s credit have no right to contest, in court or otherwise, the amount of the bureau report anytime during the life of the offer‑in‑compromise. tax liability. This offer‑in‑compromise shall not be admissible in The department’s obtaining a credit bureau report is not to be any proceeding for any other period or with respect to any other interpreted as its agreement to accept the offer‑in‑compromise. matter. While your offer‑in‑compromise is under consideration, the This offer‑in‑compromise applies only to the tax liabilities that department may withhold collection activities unless the exist at the time of the receipt of the proposed offer‑in‑compromise. department finds that collection may be jeopardized by a delay. In the event that an additional tax liability for the same or different The decision to resume collection activities may be appealed to period(s) or type(s) is ascertained by the department in any manner the Problem Resolution Officer. The decision of the Problem including audits, amended returns, etc., this offer shall neither Resolution Officer is final as to both the department and the serve as a waiver or admission by the department nor preclude taxpayer. The offer‑in‑compromise process is defined as the the department from taking any actions necessary to collect that period which commences upon receipt of the offer‑in‑compromise liability. and continues through the conclusion of receipt, posting of the final payment and issuance of a release of lien. The statute of Taxpayer agrees that the department shall retain any/all amounts limitations with respect to collections is tolled during the duration to which the taxpayer may be entitled pursuant to the Arizona tax of the offer‑in‑compromise process and all amounts included in laws as a result of overpayments of any tax, including, transaction the accepted offer‑in‑compromise will be automatically tolled as privilege, withholding, income tax, plus any interest thereon, for defined in ARS §42‑2066. any tax periods ending before this offer‑in‑compromise is fully satisfied. Any amounts the department retains pursuant to this I/We understand that I/we remain responsible for the full amount provision are in addition to the amount the taxpayer agrees to pay of the tax liability unless and until the department accepts the in this offer‑in‑compromise. offer in writing and I/we have met all the terms and conditions of the offer. The department will not remove the original amount of The department will keep all payments and credits made, received the tax liability from its records until I/we have met all the terms or applied to the total of the original tax liability before receipt of and conditions of this offer. I/We understand that noncompliance this offer. The department may keep any proceeds from a levy with any of the terms stated in this offer‑in‑compromise would be served prior to the receipt of the offer but not received at the time considered default of this agreement. The department may void the offer is submitted. If I/we have an installment agreement prior the offer‑in‑compromise and, without further notice, take any to submitting the offer, I/we must continue to make the payments action necessary to collect the remaining liability due under this as agreed until receipt of written notification that the department agreement plus accrued interest. has accepted the offer. Neither installment agreement payments nor any offset, overpayments and/or credits will be applied against I/We understand that department employees may contact third the amount offered. parties in order to respond to this request, and I/we authorize the department to make such contacts. By this authorization, I/we I/We agree to comply with all the provisions of Arizona law relating may not receive notice of such contacts. to the filing of returns and payment of any tax due for a period of three (3) years following acceptance of this offer‑in‑compromise. If I/we fail to comply with the filing and payment requirement Print Print two copies. Submit one copy with your offer. Keep one copy for yourself. ADOR 11005 (8/18) Offer-in-Compromise Page 3 of 6 |
Enlarge image | OFFER-IN-COMPROMISE • STATEMENT OF OFFER Arizona Department Of Revenue TAXPAYER NAME(S), DBA, OR CORPORATE NAME Offer I/We offer to pay $________________ in lieu of the above-mentioned liability. I/We acknowledge that the above liability is due and owing to the Arizona Department of Revenue and request that the department abate the remaining balance due pursuant to ARS §42-1004.B. By STREET ADDRESS submitting this Offer-in-Compromise, I/we understand and agree to the terms and conditions on the reverse side of CITY, STATE, ZIP CODE this form. MAIL ADDRESS (if different from above) Payment Terms Payment in full enclosed with this offer. Payment in full within: CITY, STATE, ZIP CODE 30, 60, or 90 days from the date of acceptance of this offer. PHONE NUMBER What is the source of funds for your offer? EMAIL ADDRESS Individual Income Tax YOUR SOCIAL SECURITY NUMBER AMOUNT OWED Reason for Offer $ Briefly state your reason for making this offer. Include any SPOUSE’S SOCIAL SECURITY NUMBER information that you feel is pertinent to this offer: Transaction Privilege Tax LICENSE NUMBER AMOUNT OWED $ Federal Tax Information Withholding Tax TAX LIABILITY OWED TO THE INTERNAL REVENUE SERVICE (IRS) LICENSE NUMBER AMOUNT OWED $ $ HAVE YOU SUBMITTED AN OFFER TO THE IRS? Corporate Income Tax Yes No LICENSE NUMBER AMOUNT OWED ARE YOU MAKING PAYMENTS TO THE IRS? $ Yes No IF YES, AMOUNT OF MONTHLY PAYMENT Waste Tire Tax LICENSE NUMBER AMOUNT OWED $ $ Signature(s) I/We agree with the terms and conditions set forth in this If you are submitting an Offer-in-Compromise for a business form. I/We have fully examined this offer and to the best liability, please indicate the type of your organization: of my/our knowledge and belief, it is true, correct and complete. Sole Proprietorship Partnership SIGNATURE OF TAXPAYER DATE Limited Partnership Corporation: SIGNATURE OF TAXPAYER DATE Is charter still active? Yes No LLC Other: ________________________ Print 2 copies of this Completed Statement Offer. Send one signed copy and retain one for your records. Email: oicprocessing@azdor.gov ADOR 11005 (8/18) Offer-in-Compromise Page 4 of 6 Print Offer Clear Form |
Enlarge image | Statement of Offer Form Other Important Information This booklet contains two (2) Statement of Offer Once you have submitted your offer, please allow 90 forms. Submit one (1) form with your request. Keep days for processing. If you choose to withdraw your the other form for your records. offer, please call (602) 716‑7787 and ask to speak to the Officer of the Day or your assigned Revenue It is important that you read and understand the Officer. terms and conditions provided on page 3. By signing the Statement of Offer, you agree to the terms and While your offer‑in‑compromise is under conditions stated on page 3. consideration, the department may withhold collection activities unless the department finds that collection A signed Statement of Offer and supporting otherwise may be jeopardized by a delay. The decision documentation is not an admission by the department to resume collection activities may be appealed to the that the liability is uncollectible or that any offer will Problem Resolution Officer. be accepted. The department may contact you to provide additional information. Where to submit your offer The department will notify you by mail to inform you of acceptance or denial of your offer. The You may hand deliver your offer to any Arizona department may also determine that your offer is not Department of Revenue office. See the front cover processable. You must comply with all of the terms page for office locations. You may also give your and conditions. offer to any field representative, mail, or email your offer to: Default of the offer‑in‑compromise terms and Arizona Department of Revenue conditions may result in the account balance becoming Attention: Field Collections due in full. Failure to make satisfactory arrangements PO Box 29070 to satisfy your liability may subject you to enforcement Phoenix, AZ 85038-9070 actions to secure payment of the balance without Tel: (602) 716-7787 further notice to you. OR Email: oicprocessing@azdor.gov ADOR 11005 (8/18) Offer-in-Compromise Page 5 of 6 |
Enlarge image | Checklist for required information Please include with your Statement of Offer and financial statements any of the following which apply. The department will review all information. Business: Signed Statement of Offer. Completed Collection Information Statements (financial statement business - Form 10847) and attachments. A copy of your last federal tax return. A copy of your IRS Offer-in-Compromise agreement. All bank statements 90 days prior to close of operations for all bank accounts held. Copies of credit card statements for last 90 days for all credit cards held. Individuals: Signed Statement of Offer. Completed Collection Information Statements (financial statement personal - Form 10896) and attachments. Social Security statement of benefits or disability income for all submitting parties. Copies of your last federal tax return for all submitting parties. A copy of your IRS Offer-in-Compromise agreement. Last three consecutive paystubs. Include paystubs for all parties submitting this offer. All bank statements for the last 90 days (most recent) for all bank accounts held by all submitting parties. Copies of medical bills not covered by insurance, court-ordered restitution, fines, child support, alimony, and student loan statements. Statement of prognosis from your doctor if applicable to your offer Copies of credit card statements for last 90 days for all credit cards held by all submitting parties. List of accounts receivable Copy or rental/lease agreements on property you own and lease. Copy of lease agreement if your rent is over $1,000.00. All copies or statement(s) of dividend, trust income, 401K, or other retirement accounts for all submitting parties. Print List Clear Form ADOR 11005 (8/18) Offer-in-Compromise Page 6 of 6 |