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                                                          Utah State Tax Commission
                                          210 N 1950 W  •  Salt Lake City, UT 84134  •  www.tax.utah.gov 
                                                                                                                    TC-410
                                          Offer in Compromise Request                                               Rev. 7/17

A. Taxpayer Information
Taxpayer’s name                    Social Security Number Name of personal representative / power of attorney

Spouse’s name                      Social Security Number Address

Business/corporation name          EIN                    City                                               State  ZIP Code

Physical address                                          Telephone                          Fax

City                               State ZIP Code         Email

Mailing address                                           Offer account numbers                              Periods

City                               State ZIP Code         Offer account numbers                              Periods

Taxpayer’s email                                          Offer account numbers                              Periods

B. Offer

I offer to pay (amount): ____________________

Source of funds for the offer: _________________________________________________

Reasons for the offer request (attach additional pages if necessary): ____________________________

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C. Signatures
I agree to comply with all the terms and conditions of this Offer in Compromise Request form.
Under penalty of falsification, I declare that, to the best of my knowledge, all the information in this Request and any attached 
documentation is true and complete.

___________________________________________               __________________ __________________
Taxpayer signature                                        Daytime phone number                Date (mm/dd/yyyy)

___________________________________________               __________________ __________________
Taxpayer signature                                        Daytime phone number                Date (mm/dd/yyyy)

IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.          Clear form

                                                                                                                                             TC-410_i
Instructions for Form TC-410

General Information
An Offer in Compromise is the settlement of a tax liability for less        If your account is NOT assigned to a collection agent, send your 
than full payment. The Tax Commission will only accept an Offer in          Offer in Compromise Request to:
Compromise when we find we cannot collect the full amount of the             OIC/Waiver Unit
tax liability. You have the burden of proof to justify a settlement and       Utah State Tax Commission
provide enough documentation to prove your case.                              210 N 1950
You do not have a legal right to an Offer in Compromise                       Salt Lake City, UT 84134
agreement.
                                                                            Reviewing Your Offer Request
Who Qualifies                                                               We will review your Offer in Compromise Request based on the 
We will only consider an Offer in Compromise Request after a                information you provide. 
review of your assets, liabilities, income and expenses.                    Note that additional information may be requested.
Who Does NOT Qualify                                                        If you do not qualify to have your Offer in Compromise Request 
You do not qualify for an Offer in Compromise if:                           considered, we will send you an Unmet Criteria letter.
  1. you have not filed all Utah tax returns;                               Collection Actions
  2. you are involved in an open bankruptcy;                                We may suspend collection actions while we review your Offer in 
  3. you can pay the tax liabilities within a reasonable amount of          Compromise Request and, if we reject or deny your offer, for 30 
   time; or                                                                 days after the official denial.
  4. you and the Tax Commission have not thoroughly explored all            Exceptions:
   other collection options.                                                  •  We will continue collection actions if your offer seems frivolous 
                                                                             or appears to be a delay tactic.
Ability to Pay
                                                                              •  Payments required due to an active payment agreement or 
You must base your offer on the maximum amount of the liability 
                                                                             garnishment must continue to be paid while the Offer in 
you can pay. We will consider several factors to determine your 
                                                                             Compromise Request is being reviewed and are not consid-
capacity to pay. For example:
                                                                             ered part of the offered amount.
  •  Liquidation of assets and ongoing payments will not fully pay 
                                                                              •  If a garnishment is in place against you when you submit an 
   the tax liability.
                                                                             Offer in Compromise Request, the garnishment will proceed. If 
  •  A non-liable spouse has property he or she may be willing to            your Offer in Compromise Request is accepted, the garnish-
   sell.                                                                     ment will be released at that time.
  •  A non-liable third party may consider buying your business 
   assets.                                                                  Approved Offers
  •  Amounts may be collectable through the successor liability or          We will notify you in writing if we approve your Offer in Compromise 
   personal assessments programs.                                           Request.
                                                                            We will release all tax liens within 30 days of receiving your full offer 
Payment Terms                                                               payment. For an immediate lien release, you must pay with cash or 
You must pay by certified funds within 30 days of acceptance. If you        certified funds.
are paying with personal check or credit card, it may take an 
additional 30 days to satisfy your liens.                                   Denied or Rejected Offers
                                                                            We will notify you in writing if we deny or reject your Offer in 
Submitting an Offer Request                                                 Compromise Request. There are no appeal rights for a denied offer. 
Complete and submit an Offer in Compromise Request, form                    You may discuss the denial reason(s) by contacting the collection 
TC-410. You must include a completed TC-805 for individuals                 agent noted on the denial letter. The agent will explain the denial 
and/or TC-803 for businesses.                                               and may schedule an appointment with you to discuss it further.
If the offer is being submitted by a third party, a Power of Attorney       If you remain unsatisfied, you may either:
or form TC-737 must be attached. 
                                                                              1. resubmit with missing documentation or increased offer 
See the Offer in Compromise Request Checklist for additional                 amount if your offer is rejected; or
required documentation.
                                                                              2. request a final review with Taxpayer Services Division Manage-
Requirements                                                                 ment. Send a written request to the Offer in Compromise Unit 
An Offer in Compromise Request must cover the total account                  that includes:
liability. If we accept your offer, the liability for the period(s) covered  •  A copy of the Denial of Offer letter.
by the offer is fully settled (with the exception of future audits).         •  An explanation of why an additional review is justified.
We will reject your Offer in Compromise Request if the infor-                •  Any additional information or documents which were not 
mation is incomplete or you have not provided all the required               included in your original Offer in Compromise Request.
documentation.
                                                                            After division management finishes reviewing your written request, 
How to Submit                                                               we will send a final written decision to you and your personal 
If your account is assigned to a collection agent, submit your Offer        representative.
in Compromise Request to that agent.                                         

                                                                                                                              TC-410_i2
Offer in Compromise Request Checklist

 Other collections methods have been attempted to resolve          Currently open and operating businesses submitting an Offer 
   this liability and were unsuccessful                              in Compromise Request for the business (Sole Proprietorship, 
  Power of Attorney or Personal Representative State form           Corporation, Partnership, LLC, etc.) should include:
   TC-737 for any personal representative                            Documents
  Signed Offer in Compromise Request form and/or letter              Complete copies of the filed federal business income tax 
   requesting an Offer in Compromise Agreement that                   returns for the three (3) filing periods prior to the date of the 
   includes:                                                          Offer in Compromise Request (all tax schedules and 
                                                                      worksheets)
   Total amount of the offer payment
   How the payment will be made                                     Utah State Tax Commission Collection Information for 
                                                                      
                                                                      Businesses (form TC-803) with justification statements for all 
   Lump Sum 30 days from the date of the Offer in Compro-           income and/or expenses
   mise Notice of Approval
                                                                      Copies of the business annual financial statements (balance 
   Other payment arrangement (120 days or less) with                sheets and income statements) for the previous two (2) 
   explanation                                                        annual accounting periods
   Source of the offer payment                                      Business bank statement(s) from each financial institution 
 All offer requests funded by financing or refinancing real         used for the previous two (2) months prior to the date of the 
   property have included:                                            Offer in Compromise Request
   Sales Agreement                                                  Loan application(s) and denial(s) submitted in the business 
                                                                      name within the previous six (6) months prior to the date of 
   Property Appraisal                                               the Offer in Compromise Request
   Title Report                                                    Closed Business or Corporation is submitted requesting the 
   Proposed Loan Settlement Statement (HUD 1), if applica-         offer should include:
   ble                                                               Documents
   Final Loan Settlement Statement (HUD 1)                          Verification of the closing date of the business
Individual taxpayer and/or Individual taxpayer with a closed          Description and disposition of all the business assets
business (e.g. Sole Proprietorship, General Partnership, 
Non-Payment Penalty assessed Individual(s))                           Sales agreement(s) regarding the sale of the business

Documents                                                            _______________________________
 Federal Income tax returns for the three (3) filing periods prior 
   to the date of the Offer in Compromise Request (include all 
                                                                     If you need an accommodation under the Americans with Disabili-
   W-2s, tax schedules and worksheets)
                                                                     ties Act, email taxada@utah.gov, or call 801-297-3811 or TDD 
 Utah State Tax Commission Collection Information for              801-297-2020. Please allow three working days for a response.
   Individuals (form TC-805) with justification statements for all 
   income and/or expenses
 Income verification for the previous two (2) months prior to the 
   date of the Offer in Compromise Request (e.g. pay state-
   ments, IRS 1099 forms, Social Security Benefit Statement 
   SAA-1099s, etc.)
 Bank statement(s) from each financial institution used for the 
   previous two (2) months prior to the date of the Offer in 
   Compromise Request
 Loan application(s) and denial(s) submitted within the 
   previous six (6) months prior to the date of the Offer in 
   Compromise Request
 Medical documentation for claims of disabilities or medical 
   conditions limiting abilities and/or employment (e.g. Annual 
   Social Security Disability Statement, signed statement from a 
   doctor or medical clinic verifying your condition(s), etc.)