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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
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