Form 2000 - 4 
 
                Arkansas Department of Finance and Administration 
                       Settlement or Compromise of Tax Liability 
                                                                       
 Submit this Form and other items listed in the checklist on page 6 via postal mail to the 
                       following address. Please do not submit via fax or email. 
                                                                       
           An application without the required attachments will be returned for completion. 
                                      Department of Finance and Administration 
                                      OIC Program 
                                      P.O. Box 2717 
                                              Little Rock, AR 72203-2717 
                                      Telephone – (501) 682-7751 
 
Item 1- Name of Individual Taxpayer or Primary Business Owner, Home Address & Telephone  
 
Name: 
 
Street Address: 
 
City, State, ZIP Code: 
 
Telephone Number: (           ) 
 
Fax Number:            (            ) 
 
E-mail Address:                                                     @ 
 
Item 2 – Business Name, Address and Telephone Number 
 
Business Name: 
 
Street Address: 
 
City, State, ZIP Code: 
 
Telephone Number:   (             ) 
 
Fax Number:            (           ) 
 
Item 3 - Social Security Numbers  - Individual Taxpayer’s or Business Owner’s 
                                                                        
(a) Primary:                                                           (b) Secondary: 
 
Item 4 – Sales Tax Permit Number 
 
Item 5 – Federal Employer Identification Numbers or other Permit Numbers  
 
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Item 6 – To:  Assistant Commissioner of Revenue  
 
I/We submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional 
amounts required by law for the tax type and period marked below. Mark an “X” in the box by the correct type of tax 
and list the period(s) included in your offer. 
 
   Individual Income Tax – List Year(s) 
 
   Withholding Tax  – List Months and Years 
 
   Sales/Use Tax  – List Months and Years 
 
   Other Tax(es)  
 
Type(s)                                              Months/Years 
                                                        
Note:  If you need more space, attach a separate page. 
 
Item 7 – Bankruptcy 
 
List all prior bankruptcies. Attach separate sheet if needed. Please list NA, if not applicable. 
 
Date Filed           Docket Number                            Date of Discharge or Dismissal 
                                                           
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Item 8 – Why is a payment plan (equal monthly payments over specified period of time) not an 
option to settle this liability? 
 
Item 9 - I/We submit this offer for the reason(s) checked below: 
 
     Controversy Over Amount of Tax Due – “I do not believe I owe this amount.” You must include a 
detailed explanation of the reasons why you believe you do not owe the tax. 
 
    Insolvency – “I have insufficient assets and income to pay the full amount.” REFER TO CHECKLIST FOR 
ADDITIONAL ITEMS THAT MUST BE SUBMITTED WITH THIS FORM. 
 
Item 10 – Amount of offer.   
 
I/we offer to pay $______________.  This amount cannot be zero or practically zero and must be reasonable for the 
State to accept, consistent with your financial circumstances. 
 
    Paid with this offer. This payment is not deemed to be a payment on a payment plan agreement or settlement 
of any kind. It will be accepted as a good faith payment and applied to the outstanding tax debt previously detailed 
in this form.  
 
     Paid  in full within 30 days of  acceptance  of this offer by the Arkansas Department of Finance  and 
Administration. 
 
Note:  Make all checks payable to:  Arkansas Department of Finance and Administration. Payments 
other than cash must be made with certified funds, such as a cashier’s check or money order. Payment 
by credit card is available for individual income tax only. 
 
List the source of the funds in Item #10 on the line below:  
 
By submitting this offer, I/we understand and agree to the following condition: 
 
I/We understand that I/we remain responsible for the full amount of the tax liability, unless and until the 
Department of Finance and Administration accepts the 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 tax liability from 
its records until I/we have met all the terms of the offer. 
 
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                                 Explanation of Circumstances 
                                 (Individual Taxpayer/ Business Taxpayer) 
                                           
 Please  explain  why  the  Department  of  Finance  and  Administration  should  consider  this  Offer  in  Compromise. 
 Please include a statement as to why tax was not collected or remitted for the period for which the offer is being 
 made. If any liabilities listed on the financial statements (433 A/B forms) are the result of debts to family members, 
 please  specifically  detail  the  nature of the debt  and the family relationship. Use the space below  and attach 
 additional sheets if necessary. 
  
 _______________________________________  ________________________________________________ 
 Taxpayer’s or Business Name (printed)    Prepared by (if other than taxpayer) 
  
 _______________________________________  _____________                              ___________________________ 
 Signature of Taxpayer or Business Owner  Date                                       Corporate Title (if applicable) 
  
 _______________________________________  
 Spouse’s Name (if applicable) (printed) 
  
 ___________________________________      ___________  
 Signature of Spouse (if applicable)      Date 

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Instructions for the Form 2000-4, Settlement or Compromise of Tax Liability 
 
Item # 
  1.  Complete if offer is for individual, partnership, or closely held corporation. 
   
  2.  Complete if the offer is for a business debt in the form of a sole proprietorship, 
   corporation, LLC, partnership, or S corporation. 
   
  3.  Self-explanatory. 
   
  4.  Complete if the offer is for a sales tax debt.  If this number is not known, please 
   call 501-682-1895 for assistance. 
   
  5.  Complete  if the  offer is for  withholding tax,  income tax, or, if  applicable,  for 
   other taxes. 
  
  6.  Check the appropriate box and list the months/years of debt  owed to the 
   Department. Attach a separate sheet if necessary. 
   
  7.  Complete if taxpayer filed bankruptcy.  If not, list NA. 
   
  8.  This question must be answered.  Please use an additional sheet if necessary. 
   
  9.  Check either box.  If Controversy over Amount of Tax due, an explanation must 
   also be enclosed with the offer. 
   
  10. If this item is not completed, the offer will not be reviewed. It will be considered 
   an incomplete offer and will be withdrawn.  Include how the money that will be 
   used to pay the offer was obtained, i.e., borrowed money from bank, withdrew 
   savings, etc.  The amount must  be paid with certified  funds payable  to  the 
   Department of Finance and Administration. 
   
  Explanation of Circumstances.   This page must be completed.  Failure to 
  complete this will result in the offer not being reviewed. A separate page can be 
  attached if necessary.  This  form  must be  signed and dated.  If the  offer  is for 
  income tax filed by a taxpayer and spouse, both must sign the offer. If the offer is 
  for a business, an officer must sign and date the form. If someone other than the 
  taxpayer prepared the 2000-4 form, please indicate this in the space provided and 
  attach a Power of Attorney. 
   
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           Arkansas Department of Finance and Administration 
                          Offer in Compromise Checklist 
 
    If the Offer requests abatement of penalty and interest only or is submitted under 
      “Controversy over Amount of tax due,” submit items #1 and #11. 
   
    If the Offer is submitted under “Insolvency,” submit all items listed below. 
   
Failure to include ALL requested documents will cause your offer to be withdrawn from review. 
       
  1.  Completed Offer in Compromise Form 2000-4. 
       
  2.  IRS form 433A and/or 433B. 433A is completed for an individual and/or sole 
      proprietor and 433B is completed for a business. Please complete both forms if the 
      offer is for a partnership, single member LLC, or closely held corporation.  
       
  3.  Copy of the last two (2) years federal and state income tax returns, if required to 
   
      file. If not required to file, please state reasons why below and include the last two 
      (2) years income and financial statements.  
       
  4.  Copy of last three paycheck stubs or other income (i.e., pension, social security, 
   
      alimony, or rental) if applicable.    
       
  5.  Copy of bank statements with check copies or images for the last 6 months (or 12 
   
      months if tax due is  over $25,000), as  well as any other financial institution 
      statements for which you have check writing authority. 
       
  6.  Credit report less than 30 days old. 
   
  7.  IRS information, if applicable, copy  of IRS Offer in Compromise and acceptance 
      letter or other IRS arrangements. 
       
  8.  Affidavit concerning real and personal property transfers within last two (2) years. 
   
  9.  Copy of most recent real property and personal property tax assessments. 
       
  10. Order of Discharge from Bankruptcy, if applicable, complete copy of petition and 
   
      schedules, and Statement of Intent for Chapter 7. 
       
  11. Power of Attorney, if applicable. 
   
Complete and include  this checklist  with the  application.  Additional  information may  be 
requested after receipt of  the Offer in Compromise. Mail your completed and signed 
application with the documents listed above to the address listed on Page 1 of Form 2000-4. 

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