Form 9465 Installment Agreement Request - IRS tax forms

1 SPECIFICATIONSTO BE REMOVED BEFORE PRINTINGDO NOT PRINT DO NOT PRINT DO NOT PRINT DO NOT PRINTTLS, have youtransmitted all Rtext files for thiscycle update?DateActionRevised to printINSTRUCTIONS TO PRINTERSFORM 9465, PAGE 1 of 4 MARGINS: TOP 13mm (1 2"), CENTER SIDES. PRINTS: HEAD TO HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216mm (81 2") 279mm (11")PERFORATE: (NONE)OMB No. 1545-0074 Installment Agreement RequestForm9465 Department of the TreasuryInternal Revenue Service If you are filing this form with your tax return, attach it to thefront of the return. Otherwise, see first name and initialLast nameYour social security numberIf a joint return, spouse s first name and initialLast nameSpouse s social security numberYour current address (number and street). If you have a box and no home delivery, enter your box numberCity, town or post office, state, and ZIP code.

2 If a foreign address, enter city, province or state, and country. Follow the country s practice for entering thepostal this address is new since you filed your last tax return, check here Your home phone numberEnter the tax year for which you are making this Request (for example, 2005) Enter the total amount you owe as shown on your tax return (or notice)Enter the date you want to make your payment each month. Do not enter a date later than the 28th Your signatureDateSpouse s signature. If a joint return, both must ()7891112 Name of your bank or other financial institution:56 Cat. No. 14842Y(Rev. November 2005)Form9465(Rev. 11-2005)Best time for us to employer s name: AddressCity, state, and ZIP codeAddressCity, state, and ZIP codeYour work phone number()Best time for us to callEnter the amount of any payment you are making with your tax return (or notice).

3 See instructions10 Caution: Do not file this form if you are currently making payments on an Installment Agreement . Instead, call you are in bankruptcy or we have accepted your offer-in- compromise , see Bankruptcy or offer-in- compromise onpage you want to make your payments by electronic funds withdrawal from your checking account, see the instructions and fill in lines 13aand 13b. This is the most convenient way to make your payments and it will ensure that they are made on the amount you can pay each month. Make your payments as large as possible to limitinterest and penalty charges. The charges will continue until you pay in fullGeneral Instructions1110 Enter the tax return for which you are making this Request (for example, form 1040) I authorize the Treasury and its designated Financial Agent to initiate a monthly ACH electronic funds withdrawal entry tothe financial institution account indicated for payments of my federal taxes owed, and the financial institution to debit the entryto this account.

4 This authorization is to remain in full force and effect until I notify the Treasury Financial Agent to terminatethe authorization. To revoke payment, I must contact the Treasury Financial Agent at 1-800-829-1040 no later than 7business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of theelectronic payments of taxes to receive confidential information necessary to answer inquiries and resolve issues related tothe Routing numberb Account number9 For Privacy Act and Paperwork Reduction Act Notice, see page references are to the Internal Revenue Installment Agreement . Your Request for aninstallment Agreement cannot be turned down if the tax youowe is not more than $10,000 and all three of the of FormUse form 9465 to Request a monthly Installment plan if youcannot pay the full amount you owe shown on your taxreturn (or on a notice we sent you).

5 Generally, you can haveup to 60 months to pay. In certain circumstances, you canhave longer to pay or your Agreement can be approved foran amount that is less than the amount of tax you owe. Butbefore requesting an Installment Agreement , you shouldconsider other less costly alternatives, such as a bank loanIf you do not wish to enter into an Installment agreementon form 9465, the IRS offers alternative payment of these options that you may qualify for are: 120 day extension to pay, and Payroll deduction Installment information on these and other methods of payment,call credit card payment. If you have any questions about thisrequest, call SPECIFICATIONSTO BE REMOVED BEFORE PRINTINGDO NOT PRINT DO NOT PRINT DO NOT PRINT DO NOT PRINTINSTRUCTIONS TO PRINTERSFORM 9465, PAGE 2 of 4 MARGINS: TOP 13mm (1 2"), CENTER SIDES.

6 PRINTS: HEAD TO HEADPAPER: WHITE WRITING, SUB. 20. INK: BLACKFLAT SIZE: 216mm (81 2") 279mm (11")PERFORATE: (NONE) form 9465 (Rev. 11-2005)Page2IF you live in ..THEN use this address ..Alabama, Delaware, Florida, Georgia, North Carolina, Rhode Island, South Carolina,VirginiaAtlanta, GA39901 District of Columbia, Maine, Maryland,Massachusetts, New Hampshire, New York,VermontAndover, MA05501 Connecticut, Illinois, Indiana, Iowa, Michigan,Minnesota, Missouri, North Dakota, Ohio,WisconsinKansas City, MO64999 New Jersey, PennsylvaniaPhiladelphia, PA19255 Alaska, Arizona, California, Colorado, Hawaii,Idaho, Montana, Nebraska, Nevada, NewMexico, Oregon, South Dakota, Utah,Washington, WyomingFresno, CA93888 Where To FileAttach form 9465 to the front of your return and send it tothe address shown in your tax return booklet.

7 If you havealready filed your return or you are filing this form inresponse to a notice, file form 9465 by itself with the InternalRevenue Service Center at the address below for the placewhere you live. No street address is you do not make your payments on time or you have anoutstanding past-due amount in a future year, you will be indefault on your Agreement and we may take enforcementAfter we receive each payment, we will send you a lettershowing the remaining amount you owe, and the due dateand amount of your next payment. But if you choose to haveyour payments automatically withdrawn from your checkingaccount, you will not receive a letter. Your bank statement isyour record of payment. You can also make your paymentsby credit card. For details on how to pay, see your tax returninstructions or visit We will also send you anannual statement showing the amount you owed at thebeginning of the year, all payments made during the year,and the amount you owe at the end of the approving your Request , we agree to let you pay the taxyou owe in monthly installments instead of immediatelypaying the amount in full.

8 All payments received will beapplied to your account in the best interests of the UnitedStates. In return, you agree to make your monthly paymentson time. You also agree to meet all your future tax means that you must have enough withholding orestimated tax payments so that your tax liability for futureyears is paid in full when you timely file your return. Yourrequest for an Installment Agreement will be denied if allrequired tax returns have not been filed. Any refund due youin a future year will be applied against the amount you your refund is applied to your balance, you are stillrequired to make your regular monthly Installment will be charged a $43 fee if your Request is not include the fee with this form . After approving yourrequest, we will bill you for the fee with your first Will You Be ChargedYou will also be charged interest and may be charged alate payment penalty on any tax not paid by its due date,even if your Request to pay in installments is granted.

9 Interestand any applicable penalties will be charged until the balanceis paid in full. To limit interest and penalty charges, file yourreturn on time and pay as much of the tax as possible withyour return (or notice).If we approve your Request , we will send you a letter. It willtell you how to pay the fee and make your first installmentpayment. We will usually let you know within 30 days afterwe receive your Request whether it is approved or if this Request is for tax due on a return you filed afterMarch 31, it may take us longer than 30 days to Does the InstallmentAgreement WorkAmerican Samoa, nonpermanent residentsof Guam or the Virgin Islands*, Puerto Rico(or if excluding income under InternalRevenue Code Section 933), dual-statusaliens, non-resident aliens, and anyonefiling form 4563.*Permanent residents of Guam and the Virgin Islands cannot useForm , Kansas, Kentucky, Louisiana,Mississippi, Oklahoma, Tennessee, Texas,West VirginiaAustin, TX73301 The IRS determines that you cannot pay the tax owed infull when it is due and you give the IRS any informationneeded to make that determination.

10 You agree to pay the full amount you owe within 3 yearsand to comply with the tax laws while the Agreement is Notice of Federal Tax Lien may be filed to protectthe government s interests until you pay in or offer-in- compromise . If you are inbankruptcy or we have accepted your offer-in- compromise ,do not file this form . Instead, call 1-800-829-1040 to get thenumber of your local IRS Insolvency function for bankruptcyor Technical Support function for offer-in- compromise . During the past 5 tax years, you (and your spouse if filing ajoint return) have timely filed all income tax returns and paidany income tax due, and have not entered into an installmentagreement for payment of income , such as a Notice of Federal Tax Lien or an IRS levy,to collect the entire amount you owe. To ensure that yourpayments are made timely, you should consider making themby electronic funds withdrawal (see the instructions for lines13a and 13b).