Form 14134 Form 14134 Application for Certificate of Subordination of Federal

Form

14134

(June 2010)

Department of the Treasury — Internal Revenue Service

Application for Certificate of Subordination of
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 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

3. Property Owner

Check if also the Applicant
Relationship to Taxpayer

4. Attorney/Representative Information
Name (First, Middle Initial, Last)

Attached: Form 8821 or
Power of Attorney Form 2848

Yes

No

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

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

State

Telephone Number (with area code)

Fax Number (with area code)

ZIP Code

5. Lending/Finance Company
Company Name

Contact Name

Contact Phone Number

Type of transaction (For example, loan consolidation, refinance, etc)

Catalog Number 54726H

www.irs.gov

Form 14134 (Rev. 06-2010)

Page 2 of 3

6. Monetary Information
Amount of existing loan (if refinancing)
Amount of new loan
Amount to be paid to the United States (6325(d)(1) applications only)
7. Basis for Subordination: Check the box below that best addresses what you would like the United States to consider
in your application for subordination. (Publication 784 has 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 6 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

NA

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

Real Estate:
Legible copy of deed or title showing legal description

ZIP Code

Attached

NA

9. Appraisal and Valuations
Appraisal: (Professional appraisal completed by a disinterested
third party but it is not required for a subordination)

Attached

OR ONE OF THE FOLLOWING 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

Catalog Number 54726H

www.irs.gov

Form 14134 (Rev. 06-2010)

Page 3 of 3

10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ)

Attached
OR list the lien number(s) found near the top right corner on the lien document(s) (if known)

11. Copy of the proposed loan agreement (if available)

No

Attached

No

Attached

No

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

12. Copy of a current title report (required for subordination)
OR

List encumbrances with seniority over the Federal Tax Lien. Include name and address of the holder; description of
the 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. Include any home equity line of credit (HELOCs)
advances beginning the 46th day after the NFTL was filed, through the date you submit your application, and include
expected advances through the date the certificate will be issued. (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

Yes

No

15. 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 54726H

Signature/Title

Date

Signature/Title

Date
www.irs.gov

Form 14134 (Rev. 06-2010)