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                Department of Taxation and Finance
                                                                                                                                                    DTF-4
                Offer in Compromise                                                                                                                        (6/22)
                      For liabilities not fixed and final, and subject to administrative review

Use Form DTF-4.1 instead if you do not 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.  What is the offer based on? Mark an X in one or both boxes (see instructions)
        Doubt as to liability                     Doubt as to collectibility or collection in full would cause undue economic hardship 
                                                  (must include Form DTF-5)

3.  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.

4.  Liabilities and payments
    (Attach additional pages if needed, and submit copies of all notices)
                                                                                                                        Total payments
        Assessment I.D.             Type of tax or liability      Liability period                       Amount due                                 to date

5.  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 (6/22)

 6. Conditions (please read)                                               under the Tax Law and compounded from the date of 
                                                                           default; or (c) disregard the amount of the offer and apply 
6A.   It is agreed (a) that the Commissioner of Taxation and               all amounts previously deposited under the offer against 
      Finance (the Commissioner) shall keep all payments,                  the amount of the liability sought to be compromised, 
      sums collected, and other credits made to the liabilities            immediately and without further notice file a warrant 
      asserted for the periods covered by this offer, and                  thereon and proceed to collect the balance of the 
      (b) that the Commissioner shall keep any and all                     original liability. The taxpayer(s) agrees that any pending 
      amounts to which taxpayers may be entitled under the                 conciliation conference or proceedings before the 
      Tax Law, including, but not limited to, overpayments of              Division of Tax Appeals, or any right thereto, pursuant 
      any tax or other liability, offsets, credits, or funds payable       to Tax Law §§ 170, 171, and Article 40 thereof, and the 
      to the taxpayers that are available to New York State                regulations adopted pursuant thereto, on the liability 
      (for example, lottery offsets and unclaimed funds), for              compromised, are finally and irrevocably concluded or 
      periods ending before, or within, or as of the end of the            waived, as the case may be.
      calendar year in which this offer is accepted (and which 
      are not in excess of the difference between the liability        6D. It is understood that this offer will be considered and 
      sought to be compromised and the amount offered).                    acted upon in due course and does not relieve the 
                                                                           taxpayer(s) from the liability sought to be compromised, 
6B.   Any payments made under the terms of this offer shall                unless and until the offer is accepted in writing by the 
      be applied, unless otherwise agreed in writing, to the               Commissioner, and there has been full compliance with 
      liabilities of the taxpayer(s) in the order determined by            the terms of the offer and any collateral agreements.
      the Commissioner.
                                                                       6E. Taxpayers waive the benefit of any statute of limitations 
  6C. It is further agreed and consented to by the taxpayer(s)             applicable to the assessment and collection of liabilities 
      that upon notice of the acceptance of this offer, the                sought to be compromised, and agree to the suspension 
      taxpayer(s) shall have no right to contest in the Bureau             of the running of the statutory period of limitations on 
      of Conciliation and Mediation Services, the Division                 assessment and collection for the period during which 
      of Tax Appeals, any court, or otherwise, at any time,                this offer is pending, and for one year thereafter. For 
      the amount of the liability sought to be compromised.                these purposes, the offer shall be deemed pending from 
      The Tax Department will not compromise any liability,                the date of acceptance of the waiver of the statutory 
      nor satisfy any warrant, until all obligations of each               period of limitations by an authorized Tax Department 
      taxpayer under the compromise agreement, or any                      official, until the date on which the offer is formally 
      collateral agreement, are completely performed and                   accepted, rejected, or withdrawn in writing.
      satisfied. In the event of a default by any taxpayer on the 
      compromise agreement, or on any collateral agreement,            6F. Taxpayers waive any statute of limitations defenses to 
      or if this is a deferred payment offer and there is a                the assessment and collection of the liability sought to be 
      default in payment of any installment of principal or                compromised, and further waive any statute of limitations 
      interest due under its terms, or a default on any other              defenses against the issuance of new assessment(s) for 
      term that the taxpayer(s) may have agreed upon with the              the compromised liability in the event any taxpayer fails 
      Commissioner for acceptance of the deferred payments,                to comply with the terms of the offer in compromise.
      New York State, at the option of the Commissioner or 
      an official designated by him or her, may (a) proceed          6G. Taxpayers also agree to forfeit any current capital loss or 
      immediately by suit to collect the entire unpaid balance             net operating loss credits taken on any future New York 
      of the offer; or (b) proceed immediately by suit to collect          State return.
      as liquidated damages an amount equal to the liability         6H.   Taxpayers agree that during the five-year period, beginning with 
      sought to be compromised, minus any payments already                 the date the Tax Department accepts the offer, to comply with 
      received under the terms of the offer, with interest on              all provisions of the New York State Tax Law regarding filing tax 
      the unpaid balance at the annual rate(s) as established              returns and paying all required taxes on all required returns.

                                                            7.  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 eighteenth (a), the undersigned submits this offer to the Commissioner to compromise the liabilities 
described in paragraph 4 of this Form DTF-4.

Date                                                            Signature of taxpayer(s)

Date                                                            Signature of taxpayer(s)

Corporations: See instructions on page 4, Section 7.

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

Instructions

Use the correct form authorized representative, and the representative will sign on
• Use Form DTF-4, Offer in Compromise: For Liabilities Not page 2 on behalf of the fiduciary, the fiduciary must also submit
Fixed and Final, and Subject to Administrative Review, to a completed power of attorney along with the appropriate
submit your request to compromise liabilities, where you still documents. We recommend Form ET-14, Estate Tax Power
have protest or appeal rights. of Attorney. If you use another power of attorney form, it must
include the same information as the ET-14.
You may submit Form DTF-4 if there is doubt as to liability,
or doubt as to collectibility of the full amount owed (including, Specific instructions
for individuals only, when full collection would cause undue
economic hardship). For an explanation of doubt as to liability Section 1. Taxpayer information
and doubt as to collectibility, see the instructions for Section 2. Enter the full name and phone number of the taxpayer(s). If the
• Use Form DTF-4.1, Offer in Compromise: For Fixed and Final taxpayer is a business, enter the name of the business or its
Liabilities, where you do not have any protest or appeal rights. trade name (or both). If this is a joint income tax liability, both
You do not have these rights if you: spouses may submit one application and enter both names.
• owe tax, interest, or penalties due to: a math or clerical However, for any other type of joint liability, such as a
error on a return, a change the IRS made to your federal partnership, each must submit separate DTF-4 forms.
return, or your failure to pay on time the tax that you Enter the taxpayer’s Social Security number, or, for a business,
reported due on your return, or the employer identification number.
• received a Statement of Proposed Audit Changes.
Enter the taxpayer’s physical home address, mailing address if
Your liabilities are fixed and final, and may be established by a different or a PO box, and business address (if applicable).
valid warrant.
Mark an Xin a box to indicate entity type(s). If Other, fill in the
Considerations for using Form DTF-4 blank.
You must be in compliance with all paying and filing If the taxpayer has a representative, enter the name, phone
requirements for periods not included in your offer. This includes number, and address of the representative, and attach a
estimated payments, tax deposits, and similar requirements. completed power of attorney.
Submitting Form DTF-4 does not automatically suspend pending
proceedings in the Bureau of Conciliation and Mediation Section 2. Basis for compromise
Services, nor does it suspend the time for you to take any action Mark an Xto indicate what the offer is based on.
about an assessment. • Doubt as to liability (you don’t agree with the amount the Tax
Department claims you owe).
Also, submitting Form DTF-4 does not affect the interest and
penalties that continue to accrue on your liabilities. Interest is To support your claim, you must submit affidavits showing
due at the rate set by the Tax Law, from the date of the notice or the material facts of the case. You must also include certified
agreement until we receive full payment. copies of the documents of record, if any; true copies of all
other papers and documents referred to in any affidavit; and
We may require a written collateral agreement or other security, a full list of the statutes, regulations, and case law you are
to protect the Tax Department’s interest. relying on. You are responsible for completely presenting
Generally, a taxpayer may make only one offer in compromise all your facts and legal arguments. We may require you to
for a particular liability for a particular period. provide additional documentation from third parties.
• Doubt as to collectibility (you have insufficient assets and
If we accept your offer income to pay the full amount), or where collection in full
If the Tax Department accepts your offer, and you satisfy all the would cause undue economic hardship (individuals only).
terms of the offer (for example, you paid in full the offer and For there to be doubt as to collectibility, you must show that
complied with the terms of any collateral agreement), we will you have been discharged in bankruptcy, you are insolvent,
eliminate the remaining balance of your liabilities included in this or (for individuals only) that collection in full would cause you
offer. undue economic hardship.
You are considered insolvent if all your liabilities (including
Taxpayer’s representative your tax debt) exceed the fair market value of your assets.
If you have a representative, you must include a completed Undue economic hardship generally means that you are
power of attorney. We recommend POA-1, Power of Attorney, unable to pay reasonable basic living expenses, which are
available at www.tax.ny.gov. If you use another power of those providing for the health, welfare, and production of
attorney, it must include the same information as the POA-1. income for your family. We use Internal Revenue Service
(IRS) standards to help determine allowable living expenses.
Estates We also consider other factors, including the taxpayer’s age,
When Form DTF-4 is submitted by an estate fiduciary (executor employment status, and employment history; any inability to
or administrator), the fiduciary must submit a copy of the earn income because of long-term illness, medical condition,
appropriate court appointment (for example, letters testamentary or disability; and any obligation to dependents.
or letters of administration) or, if there is no court appointment,
appropriate documents as requested by the Tax Department. If
the offer in compromise will be handled by the fiduciary’s duly

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

All offers based on doubt as to collectibility or where collection Corporations: Enter the corporate name. An authorized
in full would cause the taxpayer hardship, must include: corporate signatory must sign. Print the signatory’s name and
title immediately below the signature.
• a completed Form DTF-5, Statement of Financial Condition
and Other Information (available at www.tax.ny.gov), Mailing your Form DTF-4
including copies of:
Along with your completed Form DTF-4, be sure to include
• your last three federal income tax returns, copies of all notices listed in Section 4, and all supporting
• a credit report less than 30 days old, and documents.
• your last 12 months of statements from your bank or
financial institution. If your offer is based on doubt as to collectibility or hardship,
remember to include a completed Form DTF-5. Include copies
of your federal income tax returns for the last three years, copies
Section 3. Amount offered
of the last 12 months of statements from your bank or financial
Enter the total amount you intend to offer. You must offer more institution, and all other material required by Form DTF-5.
than $0, and you cannot include any amounts previously paid or
collected against the liabilities. Mail all documents to:
For an offer based on doubt as to liability, the amount acceptable NYS TAX DEPARTMENT
depends upon the degree of doubt found in the particular case. CED OFFER IN COMPROMISE UNIT
W A HARRIMAN CAMPUS
For an offer based on doubt as to collectibility, the amount must ALBANY NY 12227-5100
be a figure we realistically expect we could collect within a
reasonable period of time. It is based on the total value of assets Private delivery services – If not using U.S. Mail, see
and the amount we could expect to collect from anticipated Publication 55, Designated Private Delivery Services.
future income. Otherwise, the amount proposed must be justified
by information you submit. More information
These instructions are intended only as a guide for preparing
Mark an X in the Yes box if all or part of the money you are Form DTF-4. For an overview, see Publication 220, Offer in
offering for the compromise is borrowed. If Yes, enter the name Compromise Program. For specific details, see regulations
and address of the source of the borrowed money, and include a Title 20 NYCRR Part 5000, Compromises, available at
list of any collateral you have pledged to secure the loan. www.dos.state.ny.us/info/nycrr.html.
Section 4. Liabilities and payments For questions, call 518-591-5000. For forms and more
List all unpaid liabilities administered by the Tax Department information, see www.tax.ny.gov.
you wish to compromise. You may not submit an offer for a tax
year or period that has not been assessed. Include copies of Checklist
all notices that you list. You can view all your unpaid liabilities
Is DTF-4 the correct form for you?
on your Online Services account. If you do not have an Online
Services account, you can visit our website at www.tax.ny.gov If you have a representative, did you enter their name,
and create one.
address and phone number? Did you include a completed
In the Type of tax or liability column, indicate whether the notice power of attorney?
is for income, sales, withholding, or some other tax or liability.
Did you enter an offer of more than $0?
If, for a particular liability, you are both personally liable and
jointly liable with another individual or separate entity such as If your offer includes borrowed money, did you enter the

a corporation, you must submit your own Form DTF-4. For joint lender’s name and address, and collateral, if any?
liabilities, if only one taxpayer’s offer is accepted and paid, the
Did you include copies of notices of unpaid liabilities?
remaining taxpayers remain liable for the outstanding balance of
the liability. An offer we accept forgives further payment only for
Did you include copies of all appropriate documents
the taxpayer whose offer was accepted.
to support your offer? If you fail to submit all required
Section 5. Grounds for the offer statements and documents, we will not process your
Provide all the facts and reasons supporting the grounds for application.
acceptance of your offer. If needed, attach additional pages, and Did you sign and date the bottom of page 2?
copies of appropriate documents, to fully and completely explain
the details of your offer. For individuals only, if your offer is based If your offer is based on doubt as to collectibility or
on undue economic hardship, explain your situation and provide
hardship, did you include a completed Form DTF-5,
supporting documentation. including copies of:
Section 6. Conditions your last three federal income tax returns (if you are not
By submitting this application, you have read, understand, and required to file, include an explanation),
agree to the terms and conditions in this section.
a credit report less than 30 days old, and
Section 7. Signatures your last 12 months of statements from your
Sign and date. If you and your spouse seek to compromise a bank or financial institution?
joint income tax liability, both must sign.

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