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                Department of Taxation and Finance
                                                                                                                        DTF-4.1
                Offer in Compromise                                                                                                                        (6/22)
                For fixed and final liabilities

Use Form DTF-4 instead if you have protest or appeal rights (see instructions).
1.  Name of taxpayer(s)/trade or business name(s)                             Telephone number            Social Security number(s)
                                                                              ( )
Physical home address                                                                                     Employer identification number (EIN)

Mailing address (if different from above, or if a PO Box number)                                          Entity type(s)

                                                                                                          Individual 
Business address
                                                                                                          Partnership
Name of taxpayer’s representative (attach power of attorney; see instructions)    Telephone number
                                                                              ( )                         Corporation
Address of taxpayer’s representative
                                                                                                          Other

2.  Total amount offered (must be more than $0)   $
    Is the sum offered in compromise borrowed money? .............................................................................................. Yes    No
    (If Yes, enter name and address of lender and list of collateral, if any, pledged to secure the loan)
 
                       You do not have to include payment with this application. However, if you do, and 
                       we do not accept your offer, we will use the money toward the amount you owe.

3.  Liabilities and payments
    (Attach additional pages if needed)
                                                                                                                        Total payments
        Assessment ID                  Type of tax or liability   Liability period                       Amount due                                 to date

4.  Provide the facts and reasons supporting the grounds for acceptance of this offer (see instructions)

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Page 2 of 4  DTF-4.1 (6/22)

 5. Conditions (please read)                                               with interest on the unpaid balance at the annual rate(s) 
                                                                           as established under the Tax Law and compounded from 
5A.   It is agreed (a) that the Commissioner of Taxation and               the date of default; or (c) disregard the amount of the 
      Finance (the Commissioner) shall keep all payments,                  offer and apply all amounts previously deposited under 
      sums collected, and other credits made to the liabilities            the offer against the amount of the liability sought to be 
      asserted for the periods covered by this offer, and                  compromised, immediately and without further notice file 
      (b) that the Commissioner shall keep any and all                     a warrant thereon and proceed to collect the balance of 
      amounts to which taxpayers may be entitled under the                 the original liability.
      Tax Law, including, but not limited to, overpayments of 
      any tax or other liability, offsets, credits, or funds payable 5D.   It is understood that this offer will be considered and 
      to the taxpayers that are available to New York State                acted upon in due course and does not relieve the 
      (for example, lottery offsets and unclaimed funds), for              taxpayer(s) from the liability sought to be compromised, 
      periods ending before, or within, or as of the end of the            unless and until the offer is accepted in writing by the 
      calendar year in which this offer is accepted (and which             Commissioner, and there has been full compliance with 
      are not in excess of the difference between the liability            the terms of the offer and any collateral agreements.
      sought to be compromised and the amount offered).  
                                                                       5E. Taxpayers waive the benefit of any statute of limitations 
5B.   Any payments made under the terms of this offer shall                applicable to the assessment and collection of liabilities 
      be applied, unless otherwise agreed in writing, to the               sought to be compromised, and agree to the suspension 
      liabilities of the taxpayer(s) in the order determined by            of the running of the statutory period of limitations on 
      the Commissioner.                                                    assessment and collection for the period during which 
                                                                           this offer is pending, and for one year thereafter. For 
  5C. It is further agreed and consented to by the taxpayer(s)             these purposes, the offer shall be deemed pending from 
      that upon notice of the acceptance of this offer, the                the date of acceptance of the waiver of the statutory 
      taxpayer(s) shall have no right to contest in any court,             period of limitations by an authorized Tax Department 
      or otherwise, at any time, the amount of the liability               official, until the date on which the offer is formally 
      sought to be compromised. The Tax Department will not                accepted, rejected, withdrawn in writing, or, if necessary, 
      compromise any liability, nor satisfy any warrant, until             approved by a justice of the Supreme Court.
      all obligations of each taxpayer under the compromise 
      agreement, or any collateral agreement, are completely         5F.   Taxpayers waive any statute of limitations defenses to 
      performed and satisfied. In the event of a default by                the assessment and collection of the liability sought to be 
      any taxpayer on the compromise agreement, or on any                  compromised, and further waive any statute of limitations 
      collateral agreement, or if this is a deferred payment               defenses against the issuance of new assessment(s) for 
      offer and there is a default in payment of any installment           the compromised liability in the event any taxpayer fails 
      of principal or interest due under its terms, or a default           to comply with the terms of the offer in compromise.
      on any other term that the taxpayer(s) may have agreed 
      upon with the Commissioner for acceptance of the               5G. Taxpayers also agree to forfeit any current capital loss or 
      deferred payments, New York State, at the option of the              net operating loss credits taken on any future New York 
      Commissioner or an official designated by him or her,                State return.
      may (a) proceed immediately by suit to collect the entire      5H.   Taxpayers agree that during the five-year period, 
      unpaid balance of the offer; or (b) proceed immediately              beginning with the date the Tax Department accepts 
      by suit to collect as liquidated damages an amount equal             the offer, to comply with all provisions of the New York 
      to the liability sought to be compromised, minus any                 State Tax Law regarding filing tax returns and paying all 
      payments already received under the terms of the offer,              required taxes on all required returns. 

                                                          6.  Signatures
Under penalties of perjury, I declare that I have examined this application, including accompanying documents, and to the best of my knowledge 
it is true, correct, and complete. I also affirm that I have read, understand, and agree to the terms and conditions above.
I authorize the New York State Department of Taxation and Finance (DTF) to contact certain third parties, including but not limited to financial 
institutions and consumer credit reporting agencies, and to obtain my consumer credit report for the purpose of verifying the information I 
provided to DTF for determining my eligibility for the Offer-in-Compromise Program. In addition, I authorize DTF to use my Social Security 
number when requesting my credit history from consumer reporting agencies or when verifying the information provided. I understand that DTF 
will not notify me about which third parties, if any, are contacted by DTF as part of this review process.
Pursuant to Tax Law § 171, subdivision fifteenth, the undersigned submits this offer to the Commissioner to compromise the liabilities described 
in paragraph 4 of this Form DTF-4.1.

Date                                                             Signature of taxpayer(s)

Date                                                             Signature of taxpayer(s)

Corporations: See instructions on page 4, Section 6.

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DTF-4.1 (6/22) Page 3 of 4

Instructions

Use the correct form All offers must include:
• Use Form DTF-4.1, Offer in Compromise: For Fixed and Final • a completed Form DTF-5, Statement of Financial Condition
Liabilities, to submit your request to compromise liabilities, (available at www.tax.ny.gov), including copies of:
where you do not have any protest or appeal rights. You do • your last three federal income tax returns,
not have these rights if you: • a credit report less than 30 days old, and
• owe tax, interest, or penalties due to: a math or clerical • your last 12 months of statements from your bank or
error on a return, a change the IRS made to your federal financial institution.
return, or your failure to pay on time the tax that you
reported due on your return, or If we accept your offer
• received a Statement of Proposed Audit Changes. If the Tax Department accepts your offer, and you satisfy all the
Your liabilities are fixed and final, and may be established by a terms of the offer (for example, you paid in full the offer and
valid warrant. complied with the terms of any collateral agreement), we will
• Use Form DTF-4, Offer in Compromise: For Liabilities Not eliminate the remaining balance of your liabilities included in this
Fixed and Final, and Subject to Administrative Review, where offer, satisfying any warrants.
you still have protest or appeal rights.
Taxpayer’s representative
Considerations for using Form DTF-4.1 If you have a representative, you must include a completed
You must be in compliance with all paying and filing power of attorney. We recommend POA-1, Power of Attorney,
requirements for periods not included in your offer. This includes available at www.tax.ny.gov. If you use another power of
estimated payments, tax deposits, and similar requirements. attorney, it must include the same information as the POA-1.
Generally, we may consider offers in compromise from the
Estates
following taxpayers:
When Form DTF-4.1 is submitted by an estate fiduciary
• individuals and businesses discharged from bankruptcy (executor or administrator), the fiduciary must submit a copy
• individuals and businesses that are insolvent (liabilities, of the appropriate court appointment (for example, letters
including tax liabilities, exceed the fair market value of assets) testamentary or letters of administration) or, if there is no court
• individuals (not businesses) for whom paying the debt in full appointment, appropriate documents as requested by the Tax
would cause undue economic hardship Department. If the offer in compromise will be handled by the
fiduciary’s duly authorized representative, and the representative
Submitting Form DTF-4.1 does not automatically suspend will sign on page 2 on behalf of the fiduciary, the fiduciary
collection of a warrant, nor does it suspend the time for you to must also submit a completed power of attorney along with the
take any action about an assessment. appropriate documents. We recommend Form ET-14, Estate Tax
Also, submitting Form DTF-4.1 does not affect the interest and Power of Attorney. If you use another power of attorney form, it
penalties that continue to accrue on your liabilities. Interest is must include the same information as the ET-14.
due at the rate set by the Tax Law, from the date of the notice or
agreement until we receive full payment. Specific instructions
We may require a written collateral agreement or other security, Section 1. Taxpayer information
to protect the Tax Department’s interest. Enter the full name and phone number of the taxpayer(s). If the
taxpayer is a business, enter the name of the business or its
Generally, a taxpayer may make only one offer in compromise trade name (or both). If this is a joint income tax liability, both
for a particular liability for a particular period. spouses may submit one application and enter both names.
However, for any other type of joint liability, such as a
Basis for compromise partnership, each must submit separate DTF-4.1 forms.
To be eligible, you must show that you have been discharged
in bankruptcy, you are insolvent, or (for individuals only) that Enter the taxpayer’s Social Security number, or, for a business,
collection in full would cause you undue economic hardship. You the EIN.
are considered insolvent if all your liabilities (including your tax Enter the taxpayer’s physical home address, mailing address if
debt) exceed the fair market value of your assets. different or a PO Box, and business address (if applicable).
Undue economic hardship generally means that you are unable Mark an X in a box to indicate entity type(s). If Other, fill in the
to pay reasonable basic living expenses, which are those blank.
providing for the health, welfare, and production of income for
your family. We use IRS standards to help determine allowable If the taxpayer has a representative, enter the name, phone
living expenses. number, and address of the representative, and attach a
completed power of attorney.
We also consider other factors, including the taxpayer’s age,
employment status, and employment history; any inability to Section 2. Amount offered
earn income because of long-term illness, medical condition, or Enter the total amount you intend to offer. You must offer more
disability; and any obligation to dependents. than $0, and you cannot include any amounts previously paid or
collected against the liabilities.

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Page 4 of 4 DTF-4.1 (6/22)

The amount must be a figure we realistically expect we could Mailing your Form DTF-4.1
collect within a reasonable period of time. It is based on the total Along with your completed Form DTF-4.1, be sure to include a
value of assets and the amount we could expect to collect from completed Form DTF-5. Include copies of your federal income
anticipated future income. Otherwise, the amount proposed must tax returns for the last three years, copies of the last 12 months
be justified by information you submit. of statements from your bank or financial institution, and all
other material required by Form DTF-5. Remember to include all
Mark an Xin the Yes box if all or part of the money you are supporting documents.
offering for the compromise is borrowed. If Yes, enter the name
and address of the source of the borrowed money, and include a Mail all documents to:
list of any collateral you have pledged to secure the loan. NYS TAX DEPARTMENT
CED OFFER IN COMPROMISE UNIT
Section 3. Liabilities and payments W A HARRIMAN CAMPUS
List all unpaid liabilities administered by the Tax Department ALBANY NY 12227-5100
you wish to compromise. You may not submit an offer for a tax
year or period that has not been assessed. You can view all your Private delivery services – If not using U.S. Mail, see
unpaid liabilities on your Online Services account. If you do not Publication 55, Designated Private Delivery Services.
have an Online Services account, you can visit our website at
www.tax.ny.gov and create one. More information
In the Type of tax or liability column, indicate whether the notice These instructions are intended only as a guide for preparing
is for income, sales, withholding, or some other tax or liability. Form DTF-4.1. For an overview, see Publication 220, Offer in
Compromise Program. For specific details, see regulations
If, for a particular liability, you are both personally liable and Title 20 NYCRR Part 5005, Compromises, available at
jointly liable with another individual or separate entity such as a www.dos.ny.gov/info/nycrr.html.
corporation, you must submit your own Form DTF-4.1. For joint
liabilities, if only one taxpayer’s offer is accepted and paid, the For questions, call 518-591-5000. For forms and more
remaining taxpayers remain liable for the outstanding balance of information, see www.tax.ny.gov.
the liability. An offer we accept forgives further payment only for
the taxpayer whose offer was accepted. Checklist
Is DTF-4.1 the correct form for you?
Section 4. Grounds for the offer
Provide all the facts and reasons supporting the grounds for If you have a representative, did you enter their name,
acceptance of your offer. If needed, attach additional pages, and
address and phone number? Did you include a completed
copies of appropriate documents, to fully and completely explain power of attorney?
the details of your offer. For individuals only, if your offer is based
Did you enter an offer of more than $0?
on undue economic hardship, explain your situation and provide
supporting documentation.
If your offer includes borrowed money, did you enter the

Section 5. Conditions lender’s name and address, and collateral, if any?
By submitting this application, you have read, understand, and
Did you include copies of all appropriate documents
agree to the terms and conditions in this section.
to support your offer? If you fail to submit all required
Section 6. Signatures statements and documents, we will not process your
application.
Sign and date. If you and your spouse seek to compromise a
joint income tax liability, both must sign. Did you sign and date the bottom of page 2?

Corporations: Enter the corporate name. An authorized
Did you include a completed Form DTF-5, including copies
corporate signatory must sign. Print the signatory’s name and
title immediately below the signature. of:
your last three federal income tax returns (if you are not
required to file, include an explanation),
a credit report less than 30 days old, and

your last 12 months of statements from your
bank or financial institution?
Are you compliant with all of your New York State tax filing

requirements?

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