Form 14135 Application for Certificate of Discharge of Property fro

Form

14135

(June 2010)

Department of the Treasury — Internal Revenue Service

Application for Certificate of Discharge of
Property from Federal Tax Lien

OMB No. 1545-2174

Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be
included as necessary. Additional information may be requested of you or a third party 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
(last 4 digits only)

Name Continuation (Individual First, Middle Initial, Last) or (Business d/b/a)

Secondary Social Security Number
(last 4 digits only)

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

Employer Identification Number

City

State

Telephone Number (with area code)

Fax Number (with area code)

2. Applicant Information:

ZIP Code

Check if also the Taxpayer (If not the taxpayer, attach copy of lien. See Sec.10)

Name (First, Middle Initial, Last)

Relationship to taxpayer

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

State

Telephone Number (with area code)

Fax Number (with area code)

ZIP Code

Check if also the Applicant

3. Purchase/Transferee/New Owner

Relationship to taxpayer

4. Attorney/Representative Information

Attached: Form 8821 or
Power of Attorney Form 2848

Name (First, Middle Initial, Last)

Interest Represented (e.g. taxpayer, lender, etc.)

Yes

No

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

State

Telephone Number (with area code)

Fax Number (with area code)

ZIP Code

5. Lender/Finance Company Information - or (Settlement/Escrow Company for applications under Section 6325(b)(3) only)
Company Name
Catalog Number 54727S

Contact Name
www.irs.gov

Contact Phone Number
Form 14135 (Rev. 06-2010)

Page 2 of 3

6. Monetary Information
Proposed sales price
Expected proceeds to be paid to the United States in exchange for
the certificate of discharge (Enter NA if no proceeds are anticipated)
7. Basis for Discharge: Check the box below that best addresses what you would like the United States to consider in
your application for discharge. (Publication 783 has additional descriptions of the Internal Revenue Code sections listed below.)
6325(b)(1)

Value of property remaining attached by the lien(s) is at least double the liability of the federal tax
lien(s) plus other encumbrances senior to the lien(s)

6325(b)(2)(A) The United States receives an amount not less than the value of the United States' interest.
(Note: If you are applying under 6325(b)(2)(A) and are the property owner but not the taxpayer, see also
section 16.)

6325(b)(2)(B) Interest of the United States in the property to be discharged has no value.
6325(b)(3)

Proceeds from property sale held in escrow subject to the liens and claims of the United States.

6325(b)(4)

Deposit made or bond furnished in an amount equal to the value of the United States' interest.
(Note: This selection provides a remedy under 7426(a)(4) for return of deposit but is exclusively for a property
owner not named as the taxpayer on the lien)

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

Address of real property (If this is personal property, list the address where the property is located):
Address (Number, Street, P.O. Box)
City

State

ZIP Code

FOR REAL ESTATE: a legible copy of the deed or title showing
the legal description is required

Attached

NA

FOR Discharge Requests under Section 6325(b)(1):
copy of deed(s) or title(s) for property remaining subject to the
Federal Tax Lien is required

Attached

NA

9. Appraisal and Valuations
REQUIRED APPRAISAL
Professional appraisal completed by a disinterested third party

Attached

PLUS ONE OF THE FOLLOWING ADDITIONAL VALUATIONS:
County valuation of property (real property)

Attached

Informal valuation of property by disinterested third party

Attached

Proposed selling price (for property being sold at auction)

Attached

Other:

Attached

AND for applications under Section 6325(b)(1), valuation information (of the type described above in this section) must also be
provided for property remaining subject to the lien.
Catalog Number 54727S

www.irs.gov

Form 14135 (Rev. 06-2010)

Page 3 of 3

10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ)
OR list the lien number(s) found near the top right corner on the lien document(s) (if known)

11. Copy of the sales contract/purchase agreement (if available)

Attached

No

Attached

No

Attached

No

OR
Describe how and when the taxpayer will be divested of his/her interest in the property:

12. Copy of a current title report
OR

List encumbrances 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

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

Attached

No

15. Escrow Agreement (For applications under IRC 6325(b)(3))

Attached

No

Escrow agreement must specify type of account, name and depositary for account,
conditions under which payment will be made, cost of escrow, name and address of any
party identified as part of escrow agreement, and signatures of all parties involved including
Advisory Group Manager. Terms for agreement must be reached before discharge approved.

16. WAIVER (For applications made by third parties under IRC 6325(b)(2))
If you are applying as an owner of the property and you are not the taxpayer, to have this application considered under section
6325(b)(2), you must waive the rights that would be available if the application were made under section 6325(b)(4). If you choose
not to waive these rights, the application will be treated as one made under 6325(b)(4) and any payment will be treated like a
deposit under that section. Please check the appropriate box.
I understand that an application and payment made under section 6325(b)(2) does not provide the judicial remedy
available under section 7426(a)(4). In making such an application / payment, I waive the option to have the payment
treated as a deposit under section 6325(b)(4) and the right to request a return of funds and to bring an action under
section 7426(a)(4).

Waive

No

17. Declaration
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.

Catalog Number 54727S

Signature/Title

Date

Signature/Title

Date
www.irs.gov

Form 14135 (Rev. 06-2010)