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Catalog Number 67891D www.irs.gov
Form
14708 (9-2016)
I agree to retain all records (including, but not limited to, account statements) related to my Canadian retirement plans and all assets
subject to the 5% miscellaneous offshore penalty until six years from the date of this penalty reconsideration request. Upon request, I
agree to provide all such records to the Internal Revenue Service.
I agree that any determination made in relation to my penalty reconsideration request is final and may not be appealed.
Under penalties of perjury, I declare that I have examined this penalty reconsideration request and all accompanying schedules and
statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Signature of Taxpayer Name of Taxpayer Date
Signature of Taxpayer (if joint certification) Name of Taxpayer (if joint certification) Date
For Estates Only
Signature of Fiduciary Date
Title of Fiduciary (e.g., executor or administrator) Name of Fiduciary
For Paid Preparer Use Only (the signature of taxpayer(s) or fiduciary is required even if this form is signed by a paid preparer)
Signature of Preparer Name of Preparer Date
Firm’s name Firm’s EIN
Firm’s address City State ZIP code
Telephone number PTIN
Check if
Self-Employed
Do you want to allow another person to discuss this form with the IRS No
Yes (complete information below)
Designee’s name Telephone number
This document and any attachments must be sent to:
Internal Revenue Service
3651 South I-H 35
Stop 4305 AUSC
Attn: Streamlined Unit
Austin, TX 78741
Privacy Act and Paperwork Reduction Notice
We ask for the information on this certification by U.S. person residing in the United States for streamlined domestic offshore procedures to carry out the
Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This
information will be used to determine and collect the correct amount of tax under the terms of the streamlined filing compliance program. You are not
required to apply for participation in the streamlined filing compliance program. If you choose to apply, however, you are required to provide all the
information requested on the streamlined certification. You are not required to provide the information requested on a document that is subject to the
Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information
are confidential, as required by section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information
to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax
laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may
also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application.
Providing false information may subject you to penalties. The time needed to complete and submit the streamlined certification will vary depending on
individual circumstances. The estimated average time is: 2 hours
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signature
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