Form 2000 - 4 
 
                  Arkansas Department of Finance and Administration 
                          Settlement or Compromise of Tax Liability 
                                                                                               
   Submit this Form and other items listed in the checklist on page 6 via postal mail to the 
                         following address. Please do not submit via fax or email. 
  
             An application without the required attachments will be returned for completion. 
                                                                                               
                              Department of Finance and Administration 
                                   OIC Program 
                                   P.O. Box 2717 
                                   Little Rock, AR 72203-2717 
                                   Telephone – (501) 682-7751 
 
  Item 1- Name of Individual Taxpayer or Primary Business Owner, Home Address & Telephone 
  
  Name: 
  
  Street Address: 
  
  City, State, ZIP Code: 
                          
  Telephone Number: (     ) 
                          
  Fax Number:     (       ) 
                               
  E-mail Address:                  @ 
 
  Item 2 – Business Name, Address and Telephone Number 
  
  Business Name: 
  
  Street Address: 
  
  City, State, ZIP Code: 
  
  Telephone Number:  (      ) 
  
  Fax Number:          (  ) 
 
  Item 3 - Social Security Numbers - Individual Taxpayer’s or Business Owner’s 
                                      
  (a) Primary:                        (b) Secondary:                                           
 
  Item 4 – Sales Tax Permit Number 

  Item 5 – Federal Employer Identification Numbers or other Permit Numbers 
 
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  Item 6 – To: Assistant Commissioner of Revenue 
 
  I/We submit this offer to compromise the tax liabilities plus any interest, penalties, additions to tax, and additional 
  amounts required by law for the tax type and period marked below. Mark an “X” in the box by the correct type of tax 
  and list the period(s) included in your offer. 
 
  Individual Income Tax – List Year(s) 
 
  Withholding Tax – List Months and Years 
 
  Sales/Use Tax – List Months and Years 
 
  Other Tax(es) 
 
  Type(s)                                                Months/Years 
                                                          
  Note:  If you need more space, attach a separate page. 
 
  Item 7 – Bankruptcy 
 
  List all prior bankruptcies. Attach separate sheet if needed. Please list NA, if not applicable. 
 
  Date Filed          Docket Number                                   Date of Discharge or Dismissal 
                                                            
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 Item 8 – Why is a payment plan (equal monthly payments over specified period of time) not an 
 option to settle this liability? 
 
 Item 9 - I/We submit this offer for the reason(s) checked below: 
 
  Controversy Over Amount of Tax Due – “I do not believe I owe this amount.” You must include a 
 detailed explanation of the reasons why you believe you do not owe the tax. 
 
  Insolvency – “I have insufficient assets and income to pay the full amount.” REFER TO CHECKLIST FOR 
 ADDITIONAL ITEMS THAT MUST BE SUBMITTED WITH THIS FORM. 
 
 Item 10 – Amount of offer. 
 
 I/we offer to pay $              . This amount cannot be zero or practically zero and must be reasonable for the 
 State to accept, consistent with your financial circumstances. 
 
  Paid with this offer. This payment is not deemed to be a payment on a payment plan agreement or settlement 
 of any kind. It will be accepted as a good faith payment and applied to the outstanding tax debt previously detailed 
 in this form. 
 
       Paid  in  full  within  30  days  of  acceptance  of  this  offer  by  the  Arkansas  Department  of  Finance  and 
 Administration. 
 
 Note: Make all checks payable to:  Arkansas Department of Finance and Administration. Payments 
 other than cash must be made with certified funds, such as a cashier’s check or money order. Payment 
 by credit card is available for individual income tax only. 
 
 List the source of the funds in Item #10 on the line below: 
 
 By submitting this offer, I/we understand and agree to the following condition: 
 
 I/We understand that I/we remain responsible for the full amount of the tax liability, unless and until the 
 Department of Finance and Administration accepts the offer in writing and I/we have met all the terms 
 and conditions of the offer. The Department will not remove the original amount of the tax liability from 
 its records until I/we have met all the terms of the offer. 

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                                 Explanation of Circumstances 
                                 (Individual Taxpayer/ Business Taxpayer)                                                
 
 Please explain why the Department of Finance and Administration should consider this Offer in Compromise. 
 Please include a statement as to why tax was not collected or remitted for the period for which the offer is being 
 made. If any liabilities listed on the financial statements (433 A/B forms) are the result of debts to family members, 
 please specifically detail the nature of the debt and the family relationship. Use the space below and attach 
 additional sheets if necessary. 
 
                                                                                                                _ 
 Taxpayer’s or Business Name (printed)      Prepared by (if other than taxpayer) 
 
 Signature of Taxpayer or Business Owner    Date                                Corporate Title (if applicable) 

 Spouse’s Name (if applicable) (printed)                                         
            _                            _       _                               
 Signature of Spouse (if applicable)        Date 

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 Instructions for the Form 2000-4, Settlement or Compromise of Tax Liability 
                                                                                                    
 Item # 
 
 1.  Complete if offer is for individual, partnership, or closely held corporation. 
 
 2.  Complete if the offer is for a business debt in the form of a Sole proprietorship, Corporation, 
 LLC, Partnership, or S Corporation. 
 
 3.  Self explanatory. 
 
 4.  Complete if the offer is for Sales tax owed.  If this number is not known, please call 501-
 682-1895 for assistance. 
 
 5.  Complete if the offer is for Withholding tax, Income tax, or, if applicable, for other taxes. 
 
 6.  Check the appropriate box and list the months/years of debt owed to the Department.  
 Attach a separate sheet if necessary.  A copy of a Sales Tax Transcript, showing all 
 periods due, will suffice if the type of tax due is Sales tax. 
 
 7.  Complete if taxpayer filed bankruptcy.  If not, list NA. 
 
 8.  This question must be answered.  Please use an additional sheet if necessary. 
 
 9.  Check the appropriate box.  If Controversy over Amount of Tax due, an explanation must 
 be enclosed with the offer as to what part of the law the controversy is based. 
 
 10. Enter the amount that can be paid with the offer or within 30 days of the offer.  The amount 
 entered cannot be zero.  If this item is not completed, the offer will not be reviewed.  It will 
 be considered an incomplete offer and will be withdrawn.  In the space provided in the note, 
 include a statement identifying the source of the funds that are being used in the Offer in 
 Compromise such as, borrowed money from bank, withdrew savings, etc.  The amount 
 must be paid with certified funds payable to the Department of Finance and Administration. 
 
Waiver of Penalty and or Interest.  If the Form 2000-4 is submitted only for the purpose of waiver 
of penalty and or interest only the four pages must be completed. You must include on the 
explanation of circumstances page the reason the waiver is being requested and the facts and 
circumstances that caused the penalty and or interest to be assessed. 
 
Explanation of Circumstances.  This page must be completed.  Failure to complete this will result 
in the offer not being reviewed.  A separate page can be attached if necessary.  This form must be 
signed and dated.  If the offer is for income tax filed by a taxpayer and spouse, both must sign the 
offer.  If the offer is for a business, an owner and/or a corporate officer must sign and date the 
form.  If someone other than the taxpayer prepared the 2000-4 form, please indicate this in the 
space provided and attach a Power of Attorney. 

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            Arkansas Department of Finance and Administration 
            Offer in Compromise Checklist 
 
 ➢  If the Offer requests abatement of penalty and interest only or is submitted under 
  “Controversy over Amount of tax due,” submit items #1 and #11. 
 
 ➢  If the Offer is submitted under “Insolvency,” submit all items listed below. 
 
 Failure to include ALL requested documents will cause your offer to be withdrawn from review.       
 
 1.  Completed Offer in Compromise Form 2000-4. 
 
 2.  IRS form 433A and/or 433B. 433A is completed for an individual and/or sole 
  proprietor and 433B is completed for a business. Please complete both forms if the 
  offer is for a partnership, single member LLC, or closely held corporation. 
 
 3.  Copy of the last two (2) years federal and state income tax returns, if required to 
  file. If not required to file, please state reasons why below and include the last two 
  (2) years income and financial statements. 
 
 4.  Copy of last three paycheck stubs or other income (i.e., pension, social security, 
  alimony, or rental) if applicable. 
 
 5.  Copy of bank statements with check copies or images for the last 6 months (or 12 
  months  if  tax  due  is  over  $25,000),  as  well  as  any  other  financial  institution 
  statements for which you have check writing authority. 
 
 6.  Credit report less than 30 days old. 
 
 7.  IRS information, if applicable, copy of IRS Offer in Compromise and acceptance 
  letter or other IRS arrangements. 
 
 8.  Affidavit concerning real and personal property transfers within last two (2) years. 
 
 9.  Copy of most recent real property and personal property tax assessments. 
 
 10. Order of Discharge from Bankruptcy, if applicable, complete copy of petition and 
  schedules, and Statement of Intent for Chapter 7. 
 
 11. Power of Attorney, if applicable. 
 
 Complete  and  include  this  checklist  with  the  application.  Additional  information  may  be 
 requested  after  receipt  of  the  Offer  in  Compromise.  Mail  your  completed  and  signed 
 application with the documents listed above to the address listed on Page 1 of Form 2000-4. 

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