Tax Fiscal Audit Offer

TAX FISCAL AUDIT OFFER

Taxpayer Identification

Entity Type (check all that apply)

Entity Type Individual / Sole Proprietor C Corporation S Corporation Partnership Trust / Estate LLC Other:

Taxpayer Identification Number (TIN)

Provide the appropriate taxpayer identification number below. Enter either Social Security Number (individuals) or Employer Identification Number (businesses).

Audit and Offer Details

Audit Period: From through .

Supporting Documentation Checklist

Include all documents necessary to support the offer. Check each attachment provided.

Audited or unaudited financial statements Bank statements (most recent 12 months) Payroll records and withholding reports Federal and state tax returns for relevant periods Proof of income and expenses (invoices, contracts) Power of Attorney (if represented) Other attachments:

Representation

Is the taxpayer represented by an authorized agent or counsel in connection with this offer? Yes No

Terms, Conditions and Certifications

By submitting this Tax Fiscal Audit Offer, the taxpayer declares that the information and documentation provided are true, correct, and complete to the best of the taxpayer's knowledge. The taxpayer acknowledges and agrees that:

1. Acceptance of an offer by the tax authority will constitute a binding written agreement and may result in the waiver of certain administrative appeal rights as specified by applicable law; the taxpayer should ensure authority to bind the entity submitting this offer.
2. All amounts reported in this offer reflect the taxpayer's good faith estimate of ability to pay; material misrepresentation may subject the taxpayer to penalties, interest, and criminal prosecution where applicable.
3. Submission of this offer does not stay collection actions unless expressly provided by the accepting authority; the taxpayer may request a stay but agrees to comply with any interim collection instructions.
4. The tax authority may require additional documentation, financial verification, or interviews to evaluate the offer; failure to provide requested information may result in rejection of the offer.
5. If a representative is authorized, the taxpayer certifies that the representative is fully empowered to negotiate and bind the taxpayer for the purpose of this offer.

The taxpayer further certifies and attests to the following items (check each box to attest truthfulness):

The undersigned is authorized to execute this offer on behalf of the taxpayer identified above. All information and supporting documents attached are true, accurate, and complete. No material facts have been knowingly omitted that would affect evaluation of this offer. The taxpayer understands that false statements are subject to penalties under applicable law, including perjury.

Additional Comments / Explanation

Certification under penalty of perjury: I declare under penalty of perjury under applicable law that I have examined this offer, including any accompanying schedules and attachments, and to the best of my knowledge and belief it is true, correct, and complete.

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