IRS Tax Notice Form

IRS Tax Notice Response and Representation Agreement

This IRS Tax Notice Response and Representation Agreement (Agreement) is entered into as of Date: (the Effective Date) by and between Taxpayer Name: , Taxpayer Identification Number: , Taxpayer Address: , and Representative Name: , Representative Firm: , Representative Address: .

RECITALS

WHEREAS, Taxpayer has received an official tax notice issued by the Internal Revenue Service relating to certain tax liabilities and/or examinations; and

WHEREAS, Taxpayer desires to retain Representative to respond to, negotiate, and otherwise represent Taxpayer with respect to the referenced notice; and

WHEREAS, Representative is willing to represent Taxpayer on the terms and conditions set forth in this Agreement.

NOW, THEREFORE

In consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, the following terms have the meanings set forth below: "Notice" means the written correspondence identified in Section 3; "Representative" means the individual or firm identified above and its authorized agents; "Taxpayer" means the person or entity identified above.

2. SCOPE OF REPRESENTATION

Representative agrees to advise and represent Taxpayer with respect to the Notice, including preparing and filing responses, corresponding with the Internal Revenue Service, attending interviews or examinations, and negotiating collection alternatives where authorized. Representative is authorized to take those actions reasonably necessary to resolve the matters raised in the Notice. This Agreement does not authorize Representative to file appeals beyond administrative levels or commence litigation unless expressly agreed in writing in a separate engagement.

3. NOTICE DETAILS

Audit response/examination    Collection resolution/payment plan    Offer in compromise    Prepare/amend return    Other:

4. AUTHORITY AND POWER OF ATTORNEY

Taxpayer authorizes Representative to receive and inspect confidential tax information, to communicate with the Internal Revenue Service on Taxpayer's behalf, and to execute routine documents necessary to respond to the Notice. This authorization is limited to the matters and periods specified in Section 3 unless otherwise expanded in writing. If formal power of attorney is required by the Service, Taxpayer shall execute and deliver such document within a reasonable time.

Yes    No

5. FEES AND PAYMENT

Taxpayer agrees to compensate Representative as follows: . Representative shall bill Taxpayer for reasonable costs and expenses advanced in connection with the representation. Payment is due upon receipt of invoice unless otherwise stated.

6. RECORDS, COOPERATION AND REPRESENTATIONS

Taxpayer shall provide Representative with all information and documents necessary for a full and accurate response to the Notice. Taxpayer represents that the information provided is true, complete, and accurate to the best of Taxpayer's knowledge. Representative may rely on Taxpayer's representations and will not independently audit records unless agreed in writing.

7. CONFIDENTIALITY AND DISCLOSURE

Representative shall maintain confidentiality of Taxpayer's nonpublic information except as authorized by Taxpayer or required by law. Taxpayer expressly authorizes Representative to disclose relevant information to the Internal Revenue Service and third parties to the extent necessary to carry out the representation.

8. INDEMNIFICATION AND LIMITATION OF LIABILITY

Taxpayer agrees to indemnify and hold Representative harmless from liabilities arising from Taxpayer's failure to disclose material facts or from Taxpayer's inaccurate representations. Representative's liability for any claim arising under this Agreement shall be limited to direct damages and shall not include consequential, punitive or exemplary damages, except in cases of willful misconduct or gross negligence.

9. NOTICES

All notices, requests, consents, claims, demands, waivers and other communications under this Agreement must be in writing and addressed to the parties at their addresses set forth herein or as later designated in writing. Delivery by hand, first-class mail, nationally recognized overnight courier, or certified mail shall be effective upon receipt.

10. TERM AND TERMINATION

This Agreement shall commence on the Effective Date and continue until the conclusion of the matters described in Section 3 or until earlier terminated by either party upon written notice. Termination shall not relieve Taxpayer of the obligation to pay fees and expenses incurred prior to termination.

11. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles.

12. ENTIRE AGREEMENT

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

13. SEVERABILITY

If any provision of this Agreement is held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or impaired thereby.

14. AMENDMENTS, WAIVER AND COUNTERPARTS

No amendment or modification of this Agreement shall be effective unless in writing and signed by both parties. No waiver by either party of any breach shall be deemed a waiver of any subsequent breach. This Agreement may be executed in counterparts and executed copies delivered by electronic transmission shall be binding.

15. CERTIFICATION UNDER PENALTIES OF PERJURY

By signing below, Taxpayer certifies, under penalties of perjury, that the information provided in connection with this Agreement and any attachments is true, correct, and complete to the best of Taxpayer's knowledge. Taxpayer acknowledges that false statements or omissions may result in civil or criminal penalties.

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