Form 13982 Request to Participate in Rev. Proc. 2008-68 Foreign Ass

Department of the Treasury — Internal Revenue Service

Form

13982

(November 2008)

Request to Participate in Rev. Proc. 2008-68
Foreign Asset Disclosure Initiative

OMB No. XXXX-XXXX

You must provide all the information required under this Request by Xxxxxxxx XX, 2009 (or as otherwise
stipulated in subsequent requests from the Service for additional information) to be eligible for the initiative.

Note
Section I

Taxpayer Data

I/we request to participate in the disclosure initiative as described in Rev. Proc. 2008-XX and as contained in Internal
Revenue Bulletin 2008-XX dated Xxxxxxx XX, 2008.
1. Taxpayer name(s) (Include middle initial(s) and name of spouse if joint return)

2. Taxpayer Identification Number (EIN or SSN)

3. Passport Number(s):

4. Spouse's SSN (if joint return)

5. Street Address (No P.O. Boxes. Include taxpayer's residence address, City,
State, and ZIP Code)

6. Date(s) of Birth
7. Daytime telephone number

(
8. Are you (or your spouse) currently under examination, have
you been notified of an examination, or are you in Appeals?
Yes (Please complete items 8a and 8b)

)

9. Have you (or your spouse) previously contacted the IRS about
making a voluntary disclosure?
Yes (Complete items 9a & 9b)
No

No
8a. Name and address (Street, City, State, ZIP Code) of
IRS contact for your current examination or Appeals
matter (If applicable)

9a. Name and address (Street, City, State, ZIP Code) of
IRS contact about voluntary disclosure

8b. Telephone number of IRS contact

9b. Telephone number of IRS contact on voluntary disclosure

(

)

(

)

10. Do you have a power of attorney? (If yes, attach a copy to this request)

Yes

No

11. I believe that I qualify for the Foreign Asset Disclosure Initiative of Rev. Proc. 2008-XX because I
meet all of the requirements contained therein.

Yes

No

Section II

Instructions

Send your completed Form 13982 via e-mail to
[email protected] or by regular mail to:

If you are under examination (or in Appeals) please send a
copy of this Election to the IRS examiner (or IRS Appeals
Officer).

Internal Revenue Service
Attn: Rev. Proc. 2008-XX
P.O. Box 21229
Philadelphia, PA 19114

For additional information, please refer to the IRS website
at www.irs.gov. A link to Rev. Proc. 2008-xx will be
displayed on the main page.

Privacy Act Statement
The Privacy Act of 1974 says that when we ask you for information, we must first tell you our legal right to ask for the information, why we are asking for it, and how it will be
used. We must also tell you what could happen if you do not provide it and whether or not you must respond under the law.
This notice applies to tax returns and any papers filed with them. It also applies to any questions we need to ask you so we can complete, correct, or process your return;
figure your tax; and collect tax, interest, or penalties.
Our legal right to ask for information is found in Internal Revenue Code sections 6001, 6011, and 6012(a) and their regulations. They say that you must file a return or
statement with us for any tax you are liable for. Your response is mandatory under these sections.
Code section 6109 and its regulations say that you must show your social security number, employer identification number or individual taxpayer identification number on
what you file. Section 6109 also requires return preparers to provide their identifying numbers on the return. You must also fill in all parts of the tax form that apply to you. This
is so we know who you are and can process your return and papers.
We ask for tax return information to carry out the U.S. tax laws. We need it to figure and collect the right amount of tax. We may give the information to the Department of
Justice and to other federal agencies, as provided by law. We may also give it to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out
their tax laws. And we may give it to certain foreign governments under tax treaties they have with the United States. We may also disclose this information to federal and
state agencies to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. If you do not file a return, do not give us
the information we ask for, or provide fraudulent information, the law says that we may have to charge you penalties and, in certain cases, subject you to criminal prosecution.
We may also have to disallow the exemptions, exclusions, credits, deductions, or adjustments shown on your tax return. This could make your tax higher or delay any refund.
Interest may also be charged.

Catalog Number 52459F

www.irs.gov

Form 13982 (Rev. 11-2008)