Form 14134 Application for Certificate of Subordination of Federal

Application for Certificate of Subordination

of Federal Tax Lien

Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be included as necessary. Additional information may be requested to clarify the details of the transaction(s).

1.

Taxpayer Information (Individual or Business named on the notice of lien):

Name (Individual First, Middle Initial, Last) or (Business) as it appears on lien

Primary Social Security Number

Joint Obligor's Name (Individual First, Middle Initial, Last) or (Business d/b/a)

Secondary Social Security Number

Address (Number, Street, P.O. Box)

Employer Identification Number

City

State

Zip code

Telephone Number (with area code)

Fax Number (with area code)

2.

Applicant Information:

o

Check if also the Taxpayer (If not the taxpayer, attach copy of lien)

Name (First, Middle Initial, Last)

B.

Relation to taxpayer

Address (Number, Street, P.O. Box)

City

State

Zip code

Telephone Number (with area code)

Fax Number (with area code)

3.

Property Owner

o

Check if also the Applicant

Relationship to taxpayer

4.

Attorney/Representative Information:

Attached: Form 8821 or Power of Attorney Form 2848

o Yes

o No

Name (First, Middle Initial, Last)

Relation to transaction

Address (Number, Street, P.O. Box)

City

State

Zip code

Telephone Number (with area code)

Fax Number (with area code)

5.

Lending/Finance Company

Company Name

Contact Name

Contact Phone Number

Relationship to the transaction (i.e. loan consolidation, subrogation or substitution of creditors , new loan, etc)

6

Monetary Information

Amount of the tax debt or lien(s)

$0.00

Amount of existing loan (if refinancing)

$0.00

Amount of new loan:

$0.00

Amount to be paid to the United States (6325(d)(1) applications only)

$0.00

7.

Check Basis for Application: Next to the code section under which legal reason the United States can consider issuing a subordination certificate. (See Publication 784 for additional descriptions of the Internal Revenue Code sections listed below.)

6325(d)(1)

the United States will receive an amount equal to the lien or interest to which the certificate of subordination is issued (provide amount in Section 5 above)

6325(d)(2)

the issuance of the certificate of subordination will increase the government's interest and make collection of the tax liability easier. (Complete and attach a signed and dated statement describing how the amount the United States may ultimately realize will increase and how collection will be facilitated by the subordination.)

Statement Attached

o Yes

o No

8.

Description of property (for example, 3 bedroom rental house; 2002 Cessna twin engine airplane, serial number AT919000000000X00; etc.):

A. Address of real property or, for personal property, address where the property is located:

Address (Number, Street, P.O. Box)

City

State

Zip code

B. REAL ESTATE: legible copy of deed or title showing legal description

ATTACHED

o

Yes

o

NA

9.

Appraisal and Valuations

ATTACHED

Required Appraisal by:

Yes

No

Disinterested third party of property subject to discharge

PLUS ONE OF THE FOLLOWING ADDITIONAL VALUATIONS:

County valuation of property (real property)

Yes

No

Informal valuation of property by disinterested third party

Yes

No

Proposed selling price (for property being sold at auction)

Yes

No

Other:

Yes

No

10.

Copy of Federal Tax Lien(s)

Yes ATTACHED

No

Or List the lien number found in the top right corner of the lien

11.

Copy of the proposed loan agreement

ATTACHED

o

Yes

o

No

OR

Describe how subordination is in the best interests of the United States:

12.

Copy of a current title report

ATTACHED

o

Yes

o

No

OR

List encumbrances with senior to the Federal Tax Lien. Include name and address of holder; description of encumbrance, e.g., mortgage, state lien, etc.; date of agreement; original loan amount and interest rate; amount due at time of application; and family relationship, if applicable (Attach additional sheets as needed):

13.

Copy of proposed closing statement (aka HUD-1)

ATTACHED

o

Yes

o

No

OR

Itemize all proposed costs, commissions, and expenses of any transfer or sale associated with property (Attach additional sheets as needed):

14.

Additional information that may have a bearing on this request, such as pending litigation, explanations of unusual situations, etc., is attached for consideration

o

Yes

o

No

15. Certification Under penalties of perjury, I declare that I have examined this application, including any accompanying schedules, exhibits, affidavits, and statements and to the best of my knowledge and belief it is true, correct and complete.

Signature/Title (If applicable)

Date

Signature/Title (If applicable)

Date