Catalog Number 68986V
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.
Name (printed)
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
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dd mmm yyyy
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