FBAR consent

CONSENT TO EXTEND THE TIME TO
ASSESS CIVIL PENALTIES PROVIDED BY
31 U.S.C. § 5321 FOR FBAR VIOLATIONS
WHEREAS, the parties to this agreement desire to extend the time during which the
penalties provided by 31 U.S.C. 5321 may be assessed and collected,
WHEREAS, the parties to this agreement are aware that they have the right to refuse to sign
this consent,
______________________________________________________________________________,
(name and taxpayer identification number)
United States person, of ___________________________________________________________
(address)
_______________________________________________________________________________
and the Commissioner of the Internal Revenue Service, hereby agree and consent to the following:
(1) For violations with respect to the requirement, established under 31 U.S.C. 5314, for a
United States person to report having a financial interest in or signature authority, or other authority,
over a financial account during the calendar years_______________________________________
____________________________________________________ that was maintained with a
financial institution located in a foreign country, the amount of any penalty provided by 31 U.S.C.
5321 may be assessed at any time on or before December 31, 20__.
(2) This consent does not reduce, waive, or extend any period of limitation under 26 U.S.C.
6501 for assessing or collecting tax. This consent also does not supersede or amend any other
agreement between the United States person and the Internal Revenue Service.
This consent does not serve to shorten the statutory period of time to assess any penalty
under 31 U.S.C. 5321.

Date

Signature of the United States Person

___________________

___________________________________________

Date

Signature of Authorized Representative

___________________

___________________________________________

Date

Signature of the Commissioner’s Delegate

___________________

___________________________________________

___________________________________________
Title