MARYLAND
                                                                                                                      FORM                        COMPTROLLER OF MARYLAND
                                                                                                                      656                         OFFER IN COMPROMISE
                                                                                                                      Item 1 – Name and Address of Taxpayer(s)

                                                                                                                      Name

                                                                                                                      Name

                                                                                                                      Street Address 

                                                                                                                      City                                                               State    ZIP Code

                                                                                                                      Mailing Address (if different from above)

                                                                                                                      Street Address

                                                                                                                      City                                                               State    ZIP Code

                                                                                                                      Item 2 – Social Security Number(s)  (a) Primary                     _________________  (b) Secondary   ________________
                                                                                                                      Item 3 – Employer Identification Number                    _________________
                                                                                                                      Item 4 – Combined Registration Number   _________________
                                                                                                                      Item 5 – To: Comptroller of Maryland
                                                                                                                      I submit this offer to compromise the tax liabilities plus any interest and penalties for the tax type and period below: (Please 
                                                                                                                      mark and “X” in the box for the correct description and fill-in the correct tax period(s), adding additional periods, if needed.)
                                                                                                                                Income Tax – Tax Periods  ___________________________________________________________________________
______________________________________________________________________Periods  and– Tax UseI submit this offer                  Sales     to compromise the tax liabilities plus any interest                                                                     Tax 
________________________________________________________________________Periods – Tax Tax             and penalties forWithholding        the tax type and period below: (Please mark and 
                                                                                                      “X” in the box for the correct description and fill-in the correct tax 
                                                                                                                                Admissions and Amusement Tax – Tax Periods  ___________________________________________________________
                                                                                                                                                 period(s), adding additional periods, if needed.)
                                                                                                                                Other Tax(es) [specify type(s) and period(s)]  ____________________________________________________________
                                                                                                                      Item 6 – I submit this offer for the reason(s) checked below:
                                                                                                                                          Insufficient Resources – “I have insufficient assets and income to pay the full amount.” You must include a complete 
                                                                                                                                          financial statement, Form MD 433-A.
                                                                                                                                          Economic or other Hardship – “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.” 
                                                                                                                                          You must include a complete financial statement, Form 433-A and complete Item 9.
                                                                                                                      Item 7
                                                                                                                      I/we offer to pay $  _______________
                                                                                                                                Paid in full with this offer.
                                                                                                                                Deposit of $  _____________          is attached to this offer.
                                                                                                                                No deposit
                                                                                                                      If payment terms are requested, describe terms and conditions below.
                                                                                                                       _____________________________________________________________________________________________________

                                                                                                                       _____________________________________________________________________________________________________

                                                                                                                       _____________________________________________________________________________________________________
                                                                                                                      H&A/001 5/23

MARYLAND                                                                                                                       page 2
FORM        COMPTROLLER OF MARYLAND
656         OFFER IN COMPROMISE

Name
Item 8 – By submitting this offer, I understand and agree to the following conditions:
(a) I voluntarily submit all payments made on this offer.
(b) The Comptroller of Maryland will apply payments made under the terms of this agreement in the best interests of the state.
(c) The Comptroller of Maryland will keep all payments and credits made, received, or applied to the amount being compromised 
    before this offer was submitted. The Comptroller of Maryland will also keep any payments made under the terms of an 
    installment agreement while this offer is pending.
(d) I understand that I remain responsible for the full amount of the tax liability unless the Comptroller of Maryland accepts the 
    offer in writing and I have met all the terms and conditions of this offer.
(e) If the Comptroller of Maryland accepts the offer in writing, I waive the right to contest the amount of the tax, interest, and 
    penalty.
(f) If I fail to meet any of the terms and conditions of the offer, the offer is in default, and the Comptroller of Maryland may:
    (i)  immediately file suit or levy to collect the entire unpaid balance of the offer, without further notice of any kind;
    (ii) immediately file suit or levy to collect the original amount of the tax liability, without further notice of any kind.
If I fail to comply with all provisions of state law relating to filing my returns and paying my/our required taxes for three (3) 
years from the date the Comptroller of Maryland accepts the offer, the Comptroller of Maryland may treat the offer as defaulted 
and reinstate the unpaid balance. The Comptroller of Maryland will continue to add interest, as required by law, on the amount 
the Comptroller of Maryland determines is due after default. The Comptroller of Maryland will add interest from the date the 
offer is defaulted until I completely satisfy the amount owed.
Item 9 – Explanation of Circumstances
I am requesting an offer in compromise for the reason(s) listed below:
 _______________________________________________________________________________________________________
 _______________________________________________________________________________________________________
 _______________________________________________________________________________________________________
 _______________________________________________________________________________________________________
 _______________________________________________________________________________________________________

Signature of Power of Attorney                        Date    Under penalties of perjury, I declare that I have examined 
                                                              this offer, including accompanying schedules and statements, 
                                                              and to the best of my knowledge and belief, it is true, correct 
                                                              and complete.

                                                              Signature of Taxpayer                                            Date

                                                              Signature of Taxpayer                                            Date

H&A/001 5/23