14708 Streamlined Domestic Penalty Reconsideration Request Rel

Form

14708

(September 2016)

Department of the Treasury - Internal Revenue Service

OMB Number
1545-2241

Streamlined Domestic Penalty Reconsideration
Request Related to Canadian Retirement Plans

Note: Before completing this form, please review the “Streamlined Filing Compliance Procedures for U.S. Taxpayers Residing in the
United States Frequently Asked Questions and Answers” on www.irs.gov.
Name(s) of taxpayer(s)

TIN(s) of taxpayer(s)

Mailing address of taxpayer(s)

Telephone number of taxpayer(s)

Note: If spouses previously submitted a joint certification, both spouses must sign this form. If this reconsideration request is a joint
request, the statements will be considered made on behalf of both spouses, even though singular pronouns are used.
In my original Form 14654, Certification by U.S. Person Residing in the United States for Streamlined Domestic Offshore Procedures, I
included the value of my interest in one or more Canadian retirement plans described in Rev. Proc. 2014-55 (“Canadian retirement
plans”) in the Highest Account Balance/Asset Value and paid the 5% miscellaneous offshore penalty on my Canadian retirement plans.
I certify that I am an “eligible individual” as defined in section 4.01 of Rev. Prov. 2014-55.
I have reviewed my original Form 14654, Certification by U.S. Person Residing in the United States for Streamlined Domestic Offshore
Procedures, and the documents I relied upon in preparing my certification. I have recomputed the Highest Account Balance/Asset
Value and the Miscellaneous Offshore Penalty for my 3-year covered tax return period and 6-year covered FBAR period by removing
the value of my Canadian retirement plans as follows:
Line 1. Previously Reported Miscellaneous Offshore Penalty

1.

Line 2. Revised Miscellaneous Offshore Penalty

2.

Line 3. Requested Refund of Miscellaneous Offshore Penalty (line 1 minus line 2)

3.

If your revised Highest Account Balance/Asset Value is for a year different from the Highest Account Balance/Asset Value in your
original certification, please note the change below:
Original Highest Account Balance/Asset Value year
Revised Highest Account Balance/Asset Value year
Please identify your Canadian retirement plans below. If you need more space, you may attach additional pages to this form.
Name of
Financial Institution

Address of
Financial Institution

Account
Number

Year-End Balance For
Year With Highest
Account Balance
(State In U.S. Dollars)

Catalog Number 67891D

www.irs.gov

Form 14708 (9-2016)

Page 2
I agree to retain all records (including, but not limited to, account statements) related to my Canadian retirement plans and all assets
subject to the 5% miscellaneous offshore penalty until six years from the date of this penalty reconsideration request. Upon request, I
agree to provide all such records to the Internal Revenue Service.
I agree that any determination made in relation to my penalty reconsideration request is final and may not be appealed.
Under penalties of perjury, I declare that I have examined this penalty reconsideration request and all accompanying schedules and
statements, and to the best of my knowledge and belief, they are true, correct, and complete.
Signature of Taxpayer

Name of Taxpayer

Date

Signature of Taxpayer (if joint certification)

Name of Taxpayer (if joint certification)

Date

For Estates Only
Signature of Fiduciary

Date

Title of Fiduciary (e.g., executor or administrator)

Name of Fiduciary

For Paid Preparer Use Only (the signature of taxpayer(s) or fiduciary is required even if this form is signed by a paid preparer)
Signature of Preparer

Name of Preparer

Date

Firm’s name

Firm’s EIN

Firm’s address

City

Telephone number

PTIN

State

ZIP code

Check if
Self-Employed

Do you want to allow another person to discuss this form with the IRS

Yes (complete information below)

Designee’s name

No

Telephone number

This document and any attachments must be sent to:
Internal Revenue Service
3651 South I-H 35
Stop 4305 AUSC
Attn: Streamlined Unit
Austin, TX 78741
Privacy Act and Paperwork Reduction Notice
We ask for the information on this certification by U.S. person residing in the United States for streamlined domestic offshore procedures to carry out the
Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This
information will be used to determine and collect the correct amount of tax under the terms of the streamlined filing compliance program. You are not
required to apply for participation in the streamlined filing compliance program. If you choose to apply, however, you are required to provide all the
information requested on the streamlined certification. You are not required to provide the information requested on a document that is subject to the
Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document or its instructions must be
retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information
are confidential, as required by section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information
to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax
laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may
also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application.
Providing false information may subject you to penalties. The time needed to complete and submit the streamlined certification will vary depending on
individual circumstances. The estimated average time is: 2 hours
Catalog Number 67891D

www.irs.gov

Form 14708 (9-2016)