Fillable Offer in Compromise Withdrawal 2017 Form 14773

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Offer in Compromise Withdrawal 2017 Form 14773

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The Offer in Compromise Withdrawal 2017 Form 14773 form is 1 page long and contains:

  • 2 signatures
  • 2 check-boxes
  • 91 other fields

Country of origin: US
File type: PDF

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The Internal Revenue Service (IRS) is a government agency responsible for collecting taxes and administering the federal statutory tax laws of the United States. The IRS provide tax assistance to taxpayers and pursue and resolve fraudulent tax filings.

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Catalog Number 68986V www.irs.gov
Form
14773 (Rev. 12-2017)
Form 14773
(December 2017)
Department of the Treasury - Internal Revenue Service
Offer in Compromise Withdrawal
Offer number Taxpayer Identification Number (last 4 digits)
To whom it may concern:
I hereby withdraw my Offer in Compromise (OIC) dated
. I understand that by withdrawing this OIC, I waive
my appeal rights.
Signature
Name (printed)
Date
Please complete this section if you submitted a deposit with the OIC. (This does not include the non-refundable
application fee you paid.) (If you need additional space, attach a separate sheet.)
Amount of Deposit $
Check one
I wish to have my OIC deposit refunded to me.
I consent to the application against my outstanding tax liability, as shown below, of the above amount deposited on
my OIC.
Taxpayer ID Number (last 4 digits) Type of Tax Period Amount to be Applied
Sign here to acknowledge application of deposit
Date
click to sign
signature
click to edit
dd mmm yyyy
click to sign
signature
click to edit
dd mmm yyyy
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Offer in Compromise Withdrawal 2017 Form 14773

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Completed 15 May 2019

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