# Department of the Treasury — (1993) > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/agency%3Airs%3Acba590dbbba55d10 ## Record - **Collection:** Agency decision - **Document type:** Agency decision ## Text Form 9465 (Rev. Dec. 1993) Department of the Treasury — Installment Agreement Request > Please attach this completed agreement request to the front of your tax return or to the notice we sent you, and mail it to the appropriate IRS office shown on the back. Internal Revenue Service OMB Approval No. 1545-1350 Expires 11/30/96 General Information If you can't pay the amount you owe in full at this time, please request an installment agreement by completing this form. Specify the amount of the monthly payment you propose to make in the block marked "Proposed monthly payment amount." We encourage you to make your payments as large as possible to lower penalty and interest charges. Under law, these charges continue to increase until you pay the balance in full. Make your check or money order payable to the Internal Revenue Service, and mark the payment with your name, address, taxpayer identification number, form number and tax period. If you have any questions about this procedure, please call our toll-free number 1-800- 829-1040. Within 30 days, we will let you know if your request for an installment agreement is approved, or if we need more information. However, if a 1040 series tax return is filed after March 31, it may take longer than 30 days to process this request. Note: If you are currently in bankruptcy, do not use this form. Use the above toll-free telephone number and ask for the telephone number of your local IRS District Office Special Procedures function. Your first name and intital Last name Your social security number if a joint return, spouse's first name and intital Last name Spouse's social security number Home address (number and street). If you have a P.O. box without home delivery, show box number only Apt. no.| Employer identification number(for business use only) City, province or state, and postal zone or ZIP code Did this address change since you last filed? no | |ves Country, if not the United States (do not abbreviate) Business telephone number (include area code and extension number, if any) us to call you Most convenient time for | Home telephone number (include area code ) Most convenient time for us to call you Tax return or Tax period Total taxes owed on tax | Amount paid with your | Proposed monthly Date each month | am able to notice number retum or notice tax retum or notice —_ | payment amount make the payment (Must be the Ist through the 28th day) Your signature Date Spouse's signature (joint returns only) Date Privacy Act and Paperwork Reduction Act Notice We ask for the information on this form under authority of Internal Revenue Code sections 6001, 6011, 6012¢a), 6109, and 6159 and their regulations. We use this information to process your request for an installment agreement. The principal reason we need your name and social security number is to secure proper identification. We require this information to gain access to the tax information in our files and properly respond to your request. If you do not disclose the information, the IRS may not be able to process your request. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is 10 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form more simple, we would be happy to hear from you. You can write to both the Internal Revenue Service, Attention: Reports Clearance Officer, T:FP, Washington, DC 20224, and the Office of Management and Budget, Paperwork Reduction Project (1545-1350), Washington, DC 20503. DO NOT send this form to either of these offices. See the back for correct mailing addresses. Catalog No. 14842Y Form 9465 (Rev. 12/93) Where to send Form 9465, Installment Agreement Request: . *Use this address: If you live in: Internal Revenue Service Center bn Annan: ARNOT OOOO DOO ON RAR IRDR SDR OARBN ROOD OO NO nnERneSONG New Jersey, New York (New York City and counties of Holtsville, NY 00501 Nassau, Rockland, Suffolk, and Westchester) Illinois, lowa, Minnesota, Missouri, Wisconsin Kansas City, MO 64999 Indiana, Kentucky, Michigan, Ohio, West Virginia Cincinnati, OH 45999 Alaska, Arizona, California (counties of Alpine, Amador, Ogden, UT 84201 Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Sacramento, San Joaquin, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Trinity, Yolo, and Yuba), Colorado, Idaho, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming Alabama, Arkansas, Louisiana, Mississippi, North Carolina, Memphis, TN 37501 Tennessee Puerto Rica (or if excluding income under secti on 933) Virgin Islands: Nonpermanent residents All A.P.O. and F.P.O. addresses Philadelphia, PA 19255 *Use the address shown above even if you file an Form 9465 BACK (Rev. 7/93) electronic tax return to another address. --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/agency%3Airs%3Acba590dbbba55d10. Public record. Not legal advice.