Fillable DTF-4.1 Offer in Compromise For Fixed and Final (New York State)

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DTF-4.1 Offer in Compromise For Fixed and Final (New York State)

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1. Name of taxpayer(s)/trade or business name(s) Telephone number Social Security number(s)
( )
Physical home address Employer identication number (EIN)
Mailing address (if different from above, or if a PO Box number) Entity type(s)
Business address
Name of taxpayer’s representative (attach power of attorney; see instructions) Telephone number
( )
Address of taxpayer’s representative
Department of Taxation and Finance
Offer in Compromise
For Fixed and Final Liabilities
DTF-4.1
(3/19)
2. Total amount offered (must be more than $0)
Is the sum offered in compromise borrowed money? .............................................................................................. Yes No
(If Yes, enter name and address of lender and list of collateral, if any, pledged to secure the loan)
4. Provide the facts and reasons supporting the grounds for acceptance of this offer (see instructions)
Use Form DTF-4 instead if you have formal protest or appeal rights (see instructions).
$
3. Liabilities and payments
(Attach additional pages if needed)
Assessment ID Type of tax or liability Liability period Amount due
Total payments
to date
You do not have to include payment with this application. However, if you do, and
we do not accept your offer, we will use the money toward the amount you owe.
Individual
Partnership
Corporation
Other
6. Signatures
Page 2 of 4 DTF-4.1 (3/19)
5. Conditions (please read)
5A. It is agreed (a) that the Commissioner of Taxation and
Finance (“the Commissioner”) shall keep all payments,
sums collected, and other credits made to the liabilities
asserted for the periods covered by this offer, and
(b) that the Commissioner shall keep any and all
amounts to which taxpayers may be entitled under the
Tax Law, due through overpayments of any tax or other
liability, offsets, credits, or funds payable to the taxpayers
that are available to New York State (for example, lottery
offsets and unclaimed funds), for periods ending before,
or within, or as of the end of the calendar year in which
this offer is accepted (and which are not in excess
of the difference between the liability sought to be
compromised and the amount offered).
5B. Any payments made under the terms of this offer shall
be applied, unless otherwise agreed in writing, to the
liabilities of the taxpayer(s) in the order determined upon
by the Commissioner.
5C. It is further agreed and consented to by the taxpayer(s)
that upon notice of the acceptance of this offer, the
taxpayer(s) shall have no right to contest in any court,
or otherwise, at any time, the amount of the liability
sought to be compromised. The Tax Department will not
compromise any liability, nor satisfy any warrant, until
all obligations of each taxpayer under the compromise
agreement, or any collateral agreement, are completely
performed and satised. In the event of a default by
any taxpayer on the compromise agreement, or on any
collateral agreement, or if this is a deferred payment
offer and there is a default in payment of any installment
of principal or interest due under its terms, or a default
on any other term that the taxpayer(s) may have agreed
upon with the Commissioner for acceptance of the
deferred payments, New York State, at the option of the
Commissioner or an ofcial designated by him or her,
may (a) proceed immediately by suit to collect the entire
unpaid balance of the offer; or (b) proceed immediately
by suit to collect as liquidated damages an amount equal
to the liability sought to be compromised, minus any
payments already received under the terms of the offer,
with interest on the unpaid balance at the annual rate(s)
as established under the Tax Law and compounded from
the date of default; or (c) disregard the amount of the
offer and apply all amounts previously deposited under
the offer against the amount of the liability sought to be
compromised, immediately and without further notice le
a warrant thereon and proceed to collect the balance of
the original liability.
5D. It is understood that this offer will be considered and
acted upon in due course and does not relieve the
taxpayer(s) from the liability sought to be compromised,
unless and until the offer is accepted in writing by the
Commissioner, and there has been full compliance with
the terms of the offer and any collateral agreements.
5E. Taxpayers waive the benet of any statute of limitations
applicable to the assessment and collection of liabilities
sought to be compromised, and agree to the suspension
of the running of the statutory period of limitations on
assessment and collection for the period during which
this offer is pending, and for one year thereafter. For
these purposes, the offer shall be deemed pending from
the date of acceptance of the waiver of the statutory
period of limitations by an authorized Tax Department
ofcial, until the date on which the offer is formally
accepted, rejected, withdrawn in writing, or, if necessary,
approved by a justice of the Supreme Court.
5F. Taxpayers waive any statute of limitations defenses to
the assessment and collection of the liability sought to be
compromised, and further waive any statute of limitations
defenses against the issuance of new assessment(s) for
the compromised liability in the event any taxpayer fails
to comply with the terms of the offer in compromise.
5G. Taxpayers also agree to forfeit any current capital loss or
net operating loss credits taken on any future New York
State return.
5H. Taxpayers agree that during the ve-year period,
beginning with the date we accept the offer, to comply
with all provisions of the New York State Tax Law
regarding ling tax returns and paying all required taxes
on all required returns.
Under penalties of perjury, I declare that I have examined this application, including accompanying documents, and to the best of my knowledge
it is true, correct, and complete. I also afrm that I have read, understand, and agree to the terms and conditions above.
I authorize the New York State Department of Taxation and Finance (DTF) to contact certain third parties, including but not limited to nancial
institutions and consumer credit reporting agencies, and to obtain my consumer credit report for the purpose of verifying the information I
provided to DTF for determining my eligibility for the Offer-in-Compromise Program. In addition, I authorize DTF to use my Social Security
number when requesting my credit history from consumer reporting agencies or when verifying the information provided. I understand that DTF
will not notify me about which third parties, if any, are contacted by DTF as part of this review process.
Pursuant to Tax Law section 171, subdivision fteenth, the undersigned submits this offer to the Commissioner to compromise any liabilities.
Date Signature of taxpayer(s)
Date Signature of taxpayer(s)
Corporations: See instructions on page 4, Section 6.
DTF-4.1 (3/19) Page 3 of 4
Use the correct form
•
Use Form DTF-4.1, Offer in Compromise: For Fixed and Final
Liabilities, to submit your request to compromise liabilities,
where you do not have any formal protest or appeal rights.
You do not have these rights if you:
• owe tax, interest, or penalties due to: a math or clerical
error on a return, a change the IRS made to your federal
return, or your failure to pay on time the tax that you
reported due on your return, or
• received a Statement of Proposed Audit Changes.
Your liabilities are xed and nal, and may be established by a
valid warrant.
• Use Form DTF-4, Offer in Compromise: For Liabilities Not
Fixed and Final, and Subject to Administrative Review, where
you still have formal protest or appeal rights.
Considerations for using Form DTF-4.1
You must be in compliance with all paying and ling
requirements for periods not included in your offer. This includes
estimated payments, tax deposits, and similar requirements.
Generally, we may consider offers in compromise from the
following taxpayers:
• individuals and businesses discharged from bankruptcy
• individuals and businesses that are insolvent (liabilities,
including tax liabilities, exceed the fair market value of assets)
• individuals (not businesses) for whom paying the debt in full
would cause undue economic hardship
Submitting Form DTF-4.1 does not automatically suspend
collection of a warrant, nor does it suspend the time for you to
take any action about an assessment.
Also, submitting Form DTF-4.1 does not affect the interest and
penalties that continue to accrue on your liabilities. Interest is
due at the rate set by the Tax Law, from the date of the notice or
agreement until we receive full payment.
We may require a written collateral agreement or other security,
to protect the Tax Department’s interest.
Generally, a taxpayer may make only one offer in compromise
for a particular liability for a particular period.
Basis for compromise
To be eligible, you must show that you have been discharged
in bankruptcy, you are insolvent, or (for individuals only) that
collection in full would cause you undue economic hardship. You
are considered insolvent if all your liabilities (including your tax
debt) exceed the fair market value of your assets.
Undue economic hardship generally means that you are unable
to pay reasonable basic living expenses, which are those
providing for the health, welfare, and production of income for
your family. We use IRS standards to help determine allowable
living expenses.
We also consider other factors, including the taxpayer’s age,
employment status, and employment history; any inability to
earn income because of long-term illness, medical condition, or
disability; and any obligation to dependents.
All offers must include:
• a completed Form DTF-5, Statement of Financial Condition
(available at www.tax.ny.gov), including copies of:
• your last three federal income tax returns,
• a credit report less than 30 days old, and
• your last 12 months of statements from your bank or
nancial institution.
If we accept your offer
If the Tax Department accepts your offer, and you satisfy all the
terms of the offer (for example, you paid in full the offer and
complied with the terms of any collateral agreement), we will
eliminate the remaining balance of your liabilities included in this
offer, satisfying any warrants.
Taxpayer’s representative
If you have a representative, you must include a completed
power of attorney. We recommend POA-1, Power of Attorney,
available at www.tax.ny.gov. If you use another power of
attorney, it must include the same information as the POA-1.
Estates
When Form DTF-4.1 is submitted by an estate duciary
(executor or administrator), the duciary must submit a copy
of the appropriate court appointment (for example, letters
testamentary or letters of administration) or, if there is no court
appointment, appropriate documents as requested by the Tax
Department. If the offer in compromise will be handled by the
duciary’s duly authorized representative, and the representative
will sign on page 2 on behalf of the duciary, the duciary
must also submit a completed power of attorney along with the
appropriate documents. We recommend Form ET-14, Estate Tax
Power of Attorney. If you use another power of attorney form, it
must include the same information as the ET-14.
Specic instructions
Section 1. Taxpayer information
Enter the full name and phone number of the taxpayer(s). If the
taxpayer is a business, enter the name of the business or its
trade name (or both). If this is a joint income tax liability, both
spouses may submit one application and enter both names.
However, for any other type of joint liability, such as a
partnership, each must submit separate DTF-4.1 forms.
Enter the taxpayer’s Social Security number, or, for a business,
the EIN.
Enter the taxpayer’s physical home address, mailing address if
different or a PO Box, and business address (if applicable).
Mark an X in a box to indicate entity type(s). If Other, ll in the
blank.
If the taxpayer has a representative, enter the name, phone
number, and address of the representative, and attach a
completed power of attorney.
Section 2. Amount offered
Enter the total amount you intend to offer. You must offer more
than $0, and you cannot include any amounts previously paid or
collected against the liabilities.
Instructions
Page 4 of 4 DTF-4.1 (3/19)
The amount must be a gure we realistically expect we could
collect within a reasonable period of time. It is based on the total
value of assets and the amount we could expect to collect from
anticipated future income. Otherwise, the amount proposed must
be justied by information you submit.
Mark an X in the Yes box if all or part of the money you are
offering for the compromise is borrowed. If Yes, enter the name
and address of the source of the borrowed money, and include a
list of any collateral you have pledged to secure the loan.
Section 3. Liabilities and payments
List all unpaid liabilities administered by the Tax Department
you wish to compromise. You may not submit an offer for a tax
year or period that has not been assessed. You can view all your
unpaid liabilities on your Online Services account. If you do not
have an Online Services account, you can visit our website at
www.tax.ny.gov and create one.
In the Type of tax or liability column, indicate whether the notice
is for income, sales, withholding, or some other tax or liability.
If, for a particular liability, you are both personally liable and
jointly liable with another individual or separate entity such as a
corporation, you must submit your own Form DTF-4.1. For joint
liabilities, if only one taxpayer’s offer is accepted and paid, the
remaining taxpayers remain liable for the outstanding balance of
the liability. An offer we accept forgives further payment only for
the taxpayer whose offer was accepted.
Section 4. Grounds for the offer
Provide all the facts and reasons supporting the grounds for
acceptance of your offer. If needed, attach additional pages, and
copies of appropriate documents, to fully and completely explain
the details of your offer. For individuals only, if your offer is based
on undue economic hardship, explain your situation and provide
supporting documentation.
Section 5. Conditions
By submitting this application, you have read, understand, and
agree to the terms and conditions in this section.
Section 6. Signatures
Sign and date. If you and your spouse seek to compromise a
joint income tax liability, both must sign.
Corporations: Enter the corporate name. An authorized
corporate signatory must sign. Print the signatory’s name and
title immediately below the signature.
Mailing your Form DTF-4.1
Along with your completed Form DTF-4.1, be sure to include a
completed Form DTF-5. Include copies of your federal income
tax returns for the last three years, copies of the last 12 months
of statements from your bank or nancial institution, and all
other material required by Form DTF-5. Remember to include all
supporting documents.
Mail all documents to:
NYS TAX DEPARTMENT
CED OFFER IN COMPROMISE UNIT
W A HARRIMAN CAMPUS
ALBANY NY 12227-5100
Private delivery services – If not using U.S. Mail, see
Publication 55, Designated Private Delivery Services.
More information
These instructions are intended only as a guide for preparing
Form DTF-4.1. For an overview, see Publication 220, Offer in
Compromise Program. For specic details, see regulations
Title 20 NYCRR Part 5005, Compromises, available at
www.dos.ny.gov/info/nycrr.html.
For questions, call 518-591-5000. For forms and more
information, see www.tax.ny.gov.
Checklist
Is DTF-4.1 the correct form for you?
If you have a representative, did you enter their name,
address and phone number? Did you include a completed
power of attorney?
Did you enter an offer of more than $0?
If your offer includes borrowed money, did you enter the
lender’s name and address, and collateral, if any?
Did you include copies of all appropriate documents
to support your offer? If you fail to submit all required
statements and documents, we will not process your
application.
Did you sign and date the bottom of page 2?
Did you include a completed Form DTF-5, including copies
of:
your last three federal income tax returns (if you are not
required to le, include an explanation),
a credit report less than 30 days old, and
your last 12 months of statements from your
bank or nancial institution?
Are you compliant with all of your New York State tax ling
requirements?
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DTF-4.1 Offer in Compromise For Fixed and Final (New York State)

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Completed 5 July 2022

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