Date (mmddyyyy)
Catalog No. 47541C
Form 13751 (10-2005)
www.irs.gov
Signature of Taxpayer Date (mmddyyyy)
The undersigned taxpayer(s), in
accordance with Internal Revenue Code
section 6224(b), waive(s) the right to
request settlement terms with respect to
partnership items (and partnership-level
determinations of penalties, additions to
tax and additional amounts that relate to
partnership items) for the above
partnership taxable year(s) consistent with
settlement agreements entered into with
any other partner with respect to the
above taxable year(s).
1. Name and address (Street, City, State, ZIP code) 3. Name and address (Street, City, State, ZIP code)
Taxpayer Partnership
2. Taxpayer Identification Number (EIN or SSN)
5. Tax year(s) ended
4. Taxpayer Identification Number (EIN or SSN)
Signature of Taxpayer
Department of the Treasury — Internal Revenue Service
Waiver of Right to Consistent Agreement of Partnership Items
and Partnership-Level Determinations as to Penalties,
Additions to Tax, and Additional Amounts
OMB No. 1545-1969
Form 13751
(October 2005)
dd mmm yyyy
dd mmm yyyy
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