Free IRS Payment Agreement Template

IRS Payment Agreement


[Your Name]
123 Main Street
Anytown, USA 12345
Phone: (555) 123-4567
Email: [Your Email]
Social Security Number: XXX-XX-1234
Tax Year: 2049

December 17, 2050

Internal Revenue Service
Centralized Insolvency Operations
P.O. Box 1234
City, State 56789

Subject: Request for Installment Payment Agreement – SSN: XXX-XX-1234

Dear Sir/Madam,

I am writing to request an installment agreement for my outstanding tax liability for the year 2049. Due to unexpected medical expenses and a temporary reduction in income, I am unable to pay the full amount of tax due at this time. I would like to set up a reasonable installment plan to resolve my tax debt.

As of the date of this letter, I owe $7,500 in taxes, penalties, and interest for tax year 2049. I am requesting to pay off this debt in monthly installments of $200 over the next 36 months.

Financial Details:

  • Monthly Income: $3,500

  • Monthly Expenses: $2,800

    • Rent/Mortgage: $1,200

    • Utilities: $300

    • Car Payment: $350

    • Health Insurance: $250

    • Groceries: $300

    • Other Expenses: $400

Based on my current financial situation, I believe a payment of $200 per month is a manageable amount. I understand that penalties and interest will continue to accrue on the unpaid balance, but I will make every effort to stay current with my payments.

I have filed all required tax returns, including my 2049 return, and am committed to fulfilling my tax obligations. If you require additional information or documentation to support my request, please feel free to contact me at [Your Email].

I sincerely appreciate your consideration of my request and hope to reach an agreement as soon as possible. Thank you for your time and assistance.

Sincerely,

[Your Name]


Agreement Templates @ Template.net