Transcription of Form 870 Internal Revenue Service Waiver of Restrictions ...
1 TaxPenaltiesTax year ended(For instructions, see back of form )Consent to Assessment and CollectionI consent to the immediate assessment and collection of any deficiencies (increase in tax and penalties) and accept any overassessment (decrease intax and penalties) shown above, plus any interest provided by law. I understand that by signing this Waiver , I will not be able to contest these years inthe United States Tax Court, unless additional deficiencies are determined for these 870 (Rev. 3-1992)Catalog Number 16894 UYOURSIGNATUREHERESPOUSE'SSIGNATURETAXPA YER'SREPRESENTATIVEHERECORPORATENAMECORP ORATEOFFICER(S)SIGN HERED epartment of the Treasury Internal Revenue ServiceWaiver of Restrictions on Assessment and Collection ofDeficiency in Tax and Acceptance of OverassessmentNames and address of taxpayers (Number, street, city or town, State, ZIP code)Increase (Decrease) in Tax and PenaltiesSocial security or employeridentification numberDate received byInternal Revenue ServiceForm 870(Rev.)
2 March 1992)InstructionsGeneral InformationWe will consider this Waiver a valid claim for refund orcredit of any overpayment due you resulting from anydecrease in tax and penalties shown above, providedyou sign and file it within the period established by lawfor making such a Must SignIf you consent to the assessment of the deficienciesshown in this Waiver , please sign and return the form inorder to limit any interest charge and expedite theadjustment to your account. Your consent will notprevent you from filing a claim for refund (after you havepaid the tax) if you later believe you are so entitled.
3 It willnot prevent us from later determining, if necessary, thatyou owe additional tax; nor extend the time provided bylaw for either have agreements with State tax agencies underwhich information about Federal tax, including increasesor decreases, is exchanged with the States. If thischange affects the amount of your State income tax, youshould file the required State you later file a claim and the Service disallows it, youmay file suit for refund in a district court or in the UnitedStates Claims Court, but you may not file a petition withthe United States Tax you filed jointly, both you and your spouse must this Waiver is for a corporation, it should be signed withthe corporation name, followed by the signatures andtitles of the corporate officers authorized to sign.
4 Anattorney or agent may sign this Waiver provided suchaction is specifically authorized by a power of attorneywhich, if not previously filed, must accompany this this Waiver is signed by a person acting in a fiduciarycapacity (for example, an executor, administrator, or atrustee) form 56, Notice Concerning FiduciaryRelationship, should, unless previously filed, accompanythis Number:Name of Taxpayer: form 870 page 2 form 870 (Rev. 3-1992)Catalog Number 16894U
