LIEN WITHDRAWAL REQUEST LETTER

UNDERSTANDING LIEN WITHDRAWAL VS. LIEN RELEASE

Critical Distinction: A lien withdrawal and a lien release are fundamentally different remedies:

Feature	Lien Release	Lien Withdrawal
When Issued	After tax liability is paid in full or becomes unenforceable	Before or after full payment, upon request
Effect on Debt	Extinguishes the statutory lien and releases the paper NFTL	Removes public notice only; debt may still be owed
Credit Impact	Released lien may remain on credit report up to 7 years	Removes NFTL from public record as if never filed
IRS Priority	IRS no longer has priority over property	IRS relinquishes priority position against other creditors
Automatic?	Yes, within 30 days of satisfaction	No, requires written application
Form Used	Certificate of Release (Form 668(Z))	Form 10916 (Withdrawal of Filed NFTL)

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THE FOUR QUALIFYING CRITERIA FOR WITHDRAWAL UNDER IRC 6323(j)

The IRS may withdraw a Notice of Federal Tax Lien only if one or more of the following conditions are met:

Criterion 1: Premature or Improper Filing

The NFTL was filed before IRS procedures were properly followed, including:
- Filed before required notice and demand for payment
- Filed before 10-day waiting period after notice expired
- Filed without proper taxpayer identification
- Filed for incorrect tax periods or amounts
- Filed after Collection Statute Expiration Date (CSED)
- Filed in wrong recording jurisdiction

Criterion 2: Direct Debit Installment Agreement (DDIA)

The taxpayer has entered into a qualifying installment agreement under IRC § 6159 with direct debit payments. Specific requirements include:
- Unpaid assessment balance of $25,000 or less at time of request
- Full payment within 60 months or before CSED
- Minimum three consecutive successful electronic payments processed
- No prior defaults caused by taxpayer
- No previous NFTL withdrawal for same tax modules
- Applies to IMF (individual) income tax and BMF (business) income tax only

Criterion 3: Facilitates Collection

Withdrawal would help the IRS collect the tax owed, such as:
- Enabling taxpayer to refinance property and pay tax debt
- Allowing taxpayer to sell property with proceeds paying the liability
- Permitting taxpayer to obtain employment requiring credit clearance
- Enabling taxpayer to secure financing for business operations that will generate funds for payment

Criterion 4: Best Interest of Taxpayer and Government

With consent of the National Taxpayer Advocate or upon recommendation, withdrawal serves the best interest of both parties. Examples include:
- Lien severely impacts taxpayer's ability to earn income
- Economic hardship created by lien exceeds collection benefit
- Taxpayer Advocate Service intervention warranted

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FRESH START INITIATIVE: WITHDRAWAL AFTER LIEN RELEASE

Even after your lien has been released (due to full payment), you may request withdrawal to remove the public record. Eligibility requirements:

☐ Tax liability has been fully satisfied and lien has been released

☐ Compliance with filing requirements for past three years:
☐ All individual tax returns (Forms 1040)
☐ All business tax returns (Forms 1120, 1120-S, 1065, etc.)
☐ All information returns (Forms W-2, 1099, etc.)

☐ Current on all estimated tax payments

☐ Current on all federal tax deposits (if applicable)

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FORM 12277 - APPLICATION FOR WITHDRAWAL

Where to Obtain Form 12277

Form 12277 (Application for Withdrawal of Filed Form 668(Y), Notice of Federal Tax Lien) is available at www.irs.gov/pub/irs-pdf/f12277.pdf

Required Information on Form 12277

Section 1 - Taxpayer Information:
- Full legal name (individual or business entity)
- Current mailing address
- Social Security Number (SSN) or Employer Identification Number (EIN)
- Daytime telephone number

Section 2 - NFTL Information:
Provide for each NFTL to be withdrawn:
- NFTL serial number (from Form 668(Y))
- Date NFTL was filed
- Recording office where filed (county, state)
- Tax periods covered
- Original lien amount

Section 3 - Withdrawal Basis:
Check applicable box(es) indicating withdrawal criterion:
☐ Premature or improper filing
☐ Installment agreement (Direct Debit)
☐ Withdrawal will facilitate collection
☐ Best interest of taxpayer and United States

Section 4 - Explanation:
Detailed narrative supporting your withdrawal request (attach additional pages if needed)

Section 5 - Third-Party Notifications:
List credit bureaus, financial institutions, or creditors to receive copy of Form 10916 (Withdrawal Notice)

Section 6 - Signature:
Taxpayer signature (or authorized representative with valid Form 2848 Power of Attorney)

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SUPPORTING DOCUMENTATION CHECKLIST

For All Withdrawal Requests:

☐ Completed Form 12277
☐ Copy of Notice of Federal Tax Lien (Form 668(Y)) if available
☐ Copy of IRS notice showing NFTL was filed
☐ Valid photo identification
☐ Form 2848 (Power of Attorney) if representative is submitting

For Premature/Improper Filing Claims:

☐ Evidence showing procedural violation occurred
☐ CP501, CP503, CP504 notices (or lack thereof) demonstrating notice and demand issues
☐ Documentation of incorrect information on filed lien
☐ Proof of payment before lien filing (if applicable)
☐ Evidence lien filed after CSED

For Direct Debit Installment Agreement:

☐ Copy of approved Installment Agreement (Form 433-D or confirmation letter)
☐ Bank statements showing at least three consecutive successful DDIA payments
☐ Proof of current balance ($25,000 or less)
☐ Evidence of filing and payment compliance

For Facilitates Collection:

☐ Loan pre-approval letter contingent on lien withdrawal
☐ Purchase agreement or refinance documentation
☐ Letter from lender explaining withdrawal requirement
☐ Financial statement showing how withdrawal enables payment
☐ Proposed payment plan or lump sum offer

For Best Interest Determination:

☐ Form 911 (Request for Taxpayer Advocate Service Assistance) if seeking TAS involvement
☐ Documentation of economic hardship
☐ Evidence of how lien impairs earning capacity
☐ Proof of compliance efforts despite hardship
☐ Third-party letters documenting impact (employer, landlord, etc.)

For Withdrawal After Release (Fresh Start):

☐ Copy of Certificate of Release (Form 668(Z))
☐ IRS account transcript showing zero balance
☐ Three years of filed tax returns (or transcripts)
☐ Proof of current estimated tax payments
☐ Proof of current federal tax deposits (businesses)

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SAMPLE REQUEST LETTERS BY WITHDRAWAL TYPE

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SAMPLE LETTER 1: DIRECT DEBIT INSTALLMENT AGREEMENT WITHDRAWAL

[__/__/____]

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Via Certified Mail, Return Receipt Requested

Re: Application for Withdrawal of Notice of Federal Tax Lien
Taxpayer Name: [________________________________]
Social Security Number/EIN: [________________________________]
NFTL Serial Number: [________________________________]
Date NFTL Filed: [__/__/____]
Tax Period(s): [________________________________]

Dear Sir or Madam:

Pursuant to Internal Revenue Code § 6323(j)(1)(B), I respectfully request withdrawal of the above-referenced Notice of Federal Tax Lien. I have entered into a Direct Debit Installment Agreement with the IRS and meet all qualifying criteria for lien withdrawal.

Qualifying Criteria Satisfied:

☐ Current unpaid balance is $25,000 or less: $[________________________________]

☐ Agreement will satisfy liability within 60 months or before CSED

☐ At least three consecutive electronic payments successfully processed:
- Payment 1: [__/__/____] - $[________]
- Payment 2: [__/__/____] - $[________]
- Payment 3: [__/__/____] - $[________]

☐ No defaults on current or previous DDIA caused by taxpayer

☐ No previous NFTL withdrawal granted for these tax modules

☐ In compliance with all filing and payment requirements

Impact of Lien:
The filed NFTL has negatively impacted my [credit rating/ability to obtain financing/employment prospects] [________________________________]. Withdrawal would [________________________________].

Third-Party Notifications Requested:
Please send copies of Form 10916 (Withdrawal Notice) to the following:

1. [________________________________]
   [________________________________]
   [________________________________]

2. [________________________________]
   [________________________________]
   [________________________________]

3. [________________________________]
   [________________________________]
   [________________________________]

Enclosed please find:
☐ Form 12277, Application for Withdrawal
☐ Copy of NFTL (Form 668(Y))
☐ Bank statements showing DDIA payments
☐ Copy of Installment Agreement confirmation
☐ [________________________________]

I declare under penalties of perjury that the information provided is true, correct, and complete to the best of my knowledge.

Sincerely,

_________________________________________
[________________________________]
[________________________________]
[________________________________]
[________________________________]
Telephone: [________________________________]
Email: [________________________________]

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SAMPLE LETTER 2: PAID IN FULL - WITHDRAWAL AFTER RELEASE (FRESH START)

[__/__/____]

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Via Certified Mail, Return Receipt Requested

Re: Application for Withdrawal of Released Notice of Federal Tax Lien
Taxpayer Name: [________________________________]
Social Security Number/EIN: [________________________________]
NFTL Serial Number: [________________________________]
Date NFTL Filed: [__/__/____]
Date Lien Released: [__/__/____]
Tax Period(s): [________________________________]

Dear Sir or Madam:

Pursuant to Internal Revenue Code § 6323(j) and the IRS Fresh Start Initiative, I respectfully request withdrawal of the above-referenced Notice of Federal Tax Lien. The underlying tax liability has been fully satisfied and the lien has been released. I now request withdrawal to remove this public record.

Fresh Start Eligibility Criteria Satisfied:

☐ Tax liability has been paid in full

☐ Certificate of Release (Form 668(Z)) has been issued (copy enclosed)

☐ Three-year filing compliance demonstrated:
- [____] Individual return filed [__/__/____]
- [____] Individual return filed [__/__/____]
- [____] Individual return filed [__/__/____]
- [____] Business returns filed (if applicable): [________________________________]
- [____] Information returns filed (if applicable): [________________________________]

☐ Current on estimated tax payments (N/A if not required)

☐ Current on federal tax deposits (N/A if not applicable)

Reason for Withdrawal Request:
Although the lien has been released, the public record continues to [________________________________]. Withdrawal would [________________________________] and properly reflect my current tax compliance status.

Third-Party Notifications Requested:
Please send copies of Form 10916 (Withdrawal Notice) to:

1. Equifax
   P.O. Box 740256
   Atlanta, GA 30374

2. Experian
   P.O. Box 4500
   Allen, TX 75013

3. TransUnion
   P.O. Box 2000
   Chester, PA 19016

4. [________________________________]
   [________________________________]

Enclosed please find:
☐ Form 12277, Application for Withdrawal
☐ Copy of released NFTL (Form 668(Y))
☐ Copy of Certificate of Release (Form 668(Z))
☐ IRS Account Transcript showing zero balance
☐ Copies of filed returns for past three years (or transcripts)
☐ [________________________________]

I declare under penalties of perjury that the information provided is true, correct, and complete to the best of my knowledge.

Sincerely,

_________________________________________
[________________________________]
[________________________________]
[________________________________]
[________________________________]
Telephone: [________________________________]
Email: [________________________________]

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SAMPLE LETTER 3: PREMATURE OR IMPROPER FILING

[__/__/____]

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Via Certified Mail, Return Receipt Requested

Re: Application for Withdrawal of Improperly Filed Notice of Federal Tax Lien
Taxpayer Name: [________________________________]
Social Security Number/EIN: [________________________________]
NFTL Serial Number: [________________________________]
Date NFTL Filed: [__/__/____]
Tax Period(s): [________________________________]

Dear Sir or Madam:

Pursuant to Internal Revenue Code § 6323(j)(1)(A), I respectfully request withdrawal of the above-referenced Notice of Federal Tax Lien on the grounds that the filing was premature or otherwise not in accordance with IRS administrative procedures.

Procedural Violation(s):

☐ NFTL filed before proper notice and demand for payment issued
- No CP14, CP501, or other balance due notice received prior to filing
- Date of first notice received: [__/__/____]
- Date NFTL filed: [__/__/____]

☐ NFTL filed before expiration of required 10-day waiting period
- Date of Notice and Demand: [__/__/____]
- Date NFTL filed: [__/__/____] (only [____] days after notice)

☐ NFTL contains incorrect taxpayer information
- Error in name: [________________________________]
- Error in identification number: [________________________________]
- Error in address: [________________________________]

☐ NFTL filed for incorrect tax period(s)
- Period(s) shown on NFTL: [________________________________]
- Correct period(s) (if any): [________________________________]

☐ NFTL filed for incorrect amount
- Amount shown: $[________________________________]
- Correct amount owed at time of filing: $[________________________________]

☐ NFTL filed after Collection Statute Expiration Date (CSED)
- CSED for tax period: [__/__/____]
- Date NFTL filed: [__/__/____]

☐ NFTL filed in incorrect jurisdiction
- Filing location: [________________________________]
- Correct jurisdiction: [________________________________]

☐ Other procedural violation: [________________________________]

Detailed Explanation:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Request for Filing Fee Reimbursement:
Pursuant to IRM 5.12.9, because this withdrawal results from premature or improper filing, I also request reimbursement of the lien recording fee in the amount of $[________] paid to [________________________________] County.

Enclosed please find:
☐ Form 12277, Application for Withdrawal
☐ Copy of NFTL (Form 668(Y))
☐ Evidence of procedural violation:
☐ IRS notices (or absence thereof)
☐ Account transcripts
☐ [________________________________]
☐ Receipt for recording fee (if requesting reimbursement)

I declare under penalties of perjury that the information provided is true, correct, and complete to the best of my knowledge.

Sincerely,

_________________________________________
[________________________________]
[________________________________]
[________________________________]
[________________________________]
Telephone: [________________________________]
Email: [________________________________]

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SAMPLE LETTER 4: WITHDRAWAL TO FACILITATE COLLECTION

[__/__/____]

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Via Certified Mail, Return Receipt Requested

Re: Application for Withdrawal of Notice of Federal Tax Lien to Facilitate Collection
Taxpayer Name: [________________________________]
Social Security Number/EIN: [________________________________]
NFTL Serial Number: [________________________________]
Date NFTL Filed: [__/__/____]
Tax Period(s): [________________________________]
Current Balance Due: $[________________________________]

Dear Sir or Madam:

Pursuant to Internal Revenue Code § 6323(j)(1)(C), I respectfully request withdrawal of the above-referenced Notice of Federal Tax Lien on the grounds that withdrawal will facilitate collection of the tax liability.

Current Situation:
The existing NFTL prevents me from [________________________________], which would enable me to [pay the tax liability in full/make substantial payment toward the liability/enter into an installment agreement].

Proposed Collection Facilitation:

☐ Property Sale/Refinance:
- Property address: [________________________________]
- Current market value: $[________________________________]
- Existing mortgage balance: $[________________________________]
- Available equity: $[________________________________]
- Amount to be applied to tax debt: $[________________________________]
- Lender/Buyer: [________________________________]
- Contingency: Lien withdrawal required for [closing/loan approval]
- Expected closing date: [__/__/____]

☐ Business Financing:
- Lender: [________________________________]
- Loan amount: $[________________________________]
- Purpose: [________________________________]
- Amount to be applied to tax debt: $[________________________________]
- Contingency: Lien withdrawal required for loan approval

☐ Employment/Income:
- Employer/Position: [________________________________]
- Contingency: Employment requires satisfactory credit/security clearance
- Expected income from position: $[________] per [month/year]
- Amount available for tax payments: $[________] per month

☐ Other Collection Facilitation:
[________________________________]
[________________________________]

Payment Commitment:
Upon withdrawal of the NFTL, I commit to:

☐ Pay the full balance of $[________________________________] on or before [__/__/____]

☐ Make immediate partial payment of $[________________________________] with remaining balance paid by [__/__/____]

☐ Enter into Installment Agreement with monthly payments of $[________] beginning [__/__/____]

☐ Other: [________________________________]

Supporting Documentation Enclosed:
☐ Form 12277, Application for Withdrawal
☐ Copy of NFTL (Form 668(Y))
☐ Pre-approval letter from lender (dated [__/__/____])
☐ Purchase agreement or refinance application
☐ Letter from lender explaining withdrawal requirement
☐ Property appraisal
☐ Employment offer letter
☐ Financial statement (Form 433-A or 433-B)
☐ [________________________________]

I understand that if the proposed transaction does not occur or I fail to make the committed payment, the IRS may re-file a Notice of Federal Tax Lien.

I declare under penalties of perjury that the information provided is true, correct, and complete to the best of my knowledge.

Sincerely,

_________________________________________
[________________________________]
[________________________________]
[________________________________]
[________________________________]
Telephone: [________________________________]
Email: [________________________________]

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SAMPLE LETTER 5: BEST INTEREST OF TAXPAYER AND UNITED STATES

[__/__/____]

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Via Certified Mail, Return Receipt Requested

Re: Application for Withdrawal of Notice of Federal Tax Lien - Best Interest Determination
Taxpayer Name: [________________________________]
Social Security Number/EIN: [________________________________]
NFTL Serial Number: [________________________________]
Date NFTL Filed: [__/__/____]
Tax Period(s): [________________________________]

Dear Sir or Madam:

Pursuant to Internal Revenue Code § 6323(j)(1)(D), I respectfully request withdrawal of the above-referenced Notice of Federal Tax Lien on the grounds that withdrawal would be in the best interest of both the taxpayer and the United States.

Basis for Best Interest Determination:

☐ Economic Hardship:
The filed NFTL has created severe economic hardship by:
[________________________________]
[________________________________]
[________________________________]

☐ Impaired Earning Capacity:
The NFTL has directly impaired my ability to earn income because:
[________________________________]
[________________________________]

☐ Disproportionate Impact:
The continued existence of the NFTL causes harm to me that significantly exceeds any collection benefit to the government because:
[________________________________]
[________________________________]

☐ Taxpayer Advocate Service Involvement:
☐ I have filed Form 911 requesting TAS assistance (copy enclosed)
☐ TAS Case Number: [________________________________]
☐ TAS has recommended withdrawal

☐ Other Best Interest Factors:
[________________________________]
[________________________________]

Demonstrated Good Faith Compliance:
Despite the hardship caused by the NFTL, I have demonstrated good faith efforts to resolve my tax obligations:

☐ All required tax returns have been filed

☐ Current tax obligations are being met

☐ I have made the following payments toward the outstanding liability:
- [__/__/____]: $[________]
- [__/__/____]: $[________]
- [__/__/____]: $[________]

☐ I have [applied for/entered into] an Installment Agreement

☐ I have [applied for/received] an Offer in Compromise

☐ Other compliance efforts: [________________________________]

Third-Party Impact Statements:
The following individuals/entities can confirm the adverse impact of the NFTL:

1. [________________________________] (relationship: [________________________________])
   Contact: [________________________________]

2. [________________________________] (relationship: [________________________________])
   Contact: [________________________________]

Enclosed Documentation:
☐ Form 12277, Application for Withdrawal
☐ Copy of NFTL (Form 668(Y))
☐ Form 911, Request for Taxpayer Advocate Service Assistance
☐ Financial statement (Form 433-A or 433-F)
☐ Documentation of economic hardship
☐ Letters from employers, landlords, or others documenting impact
☐ Medical documentation (if health-related hardship)
☐ [________________________________]

I declare under penalties of perjury that the information provided is true, correct, and complete to the best of my knowledge.

Sincerely,

_________________________________________
[________________________________]
[________________________________]
[________________________________]
[________________________________]
Telephone: [________________________________]
Email: [________________________________]

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WHERE TO SUBMIT YOUR REQUEST

For Active Liens (Tax Still Owed):

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Fax: 855-753-8177

For Released Liens (Fresh Start Withdrawal After Payment):

Internal Revenue Service
Centralized Lien Operation
P.O. Box 145595
Cincinnati, OH 45250-5595

Alternative Submission:

If you have an assigned Revenue Officer, submit directly to them with a copy to Centralized Lien Operation.

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PROCESSING TIMELINE EXPECTATIONS

Stage	Expected Timeframe
Initial Receipt and Assignment	7 calendar days
Request for Additional Information (if needed)	Within 21 days of receipt
Taxpayer Response Deadline	Generally 30 days
IRS Recommendation Completed	Within 30 calendar days
Advisory Approval/Denial Decision	Within 10 calendar days
Withdrawal Notice Issued (if approved)	Within 15 calendar days after approval
Centralized Lien Operation Processing	Within 5 business days
Total Expected Processing Time	45-90 days (uncomplicated requests)

Note: Complex cases or those requiring additional documentation may take longer. Budget 3-6 months for the complete process.

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FOLLOW-UP PROCEDURES

Tracking Your Request:

☐ Record certified mail tracking number: [________________________________]

☐ Confirm delivery date: [__/__/____]

☐ Note 30-day follow-up date: [__/__/____]

☐ Note 60-day follow-up date: [__/__/____]

If No Response After 45 Days:

1. Call IRS Centralized Lien Operation: 800-913-6050
2. Reference your submission date and NFTL serial number
3. Request status update and estimated completion date
4. Document name of IRS representative and call reference number

If Request is Approved:

☐ Obtain copy of Form 10916 (Withdrawal of Filed Notice of Federal Tax Lien)

☐ Verify withdrawal was recorded with filing office: [________________________________]

☐ Confirm third-party notifications were sent

☐ Monitor credit reports for removal (allow 30-60 days)

☐ Contact credit bureaus directly if not updated:
- Equifax: 800-685-1111
- Experian: 888-397-3742
- TransUnion: 800-916-8800

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APPEAL RIGHTS IF DENIED

If your withdrawal request is denied, you have the right to appeal through the Collection Appeals Program (CAP).

Step 1: Request Manager Conference

Before filing a formal appeal, you may request a conference with the manager of the employee who denied your request.

Step 2: File Collection Appeal Request (Form 9423)

If the manager conference does not resolve the issue:

☐ Obtain Form 9423, Collection Appeal Request
☐ Complete within 2 business days of denial (for CAP)
☐ Explain why you disagree with the denial
☐ Attach supporting documentation
☐ Submit to the IRS employee who denied the request

Step 3: Independent Office of Appeals Review

• Appeals will review de novo (fresh review)
• Appeals has same authority as Collection to grant withdrawals
• You may present additional information to Appeals
• Appeals decision is generally final for administrative purposes

Step 4: Taxpayer Advocate Service

If you believe the denial causes significant hardship:

☐ File Form 911, Request for Taxpayer Advocate Service Assistance
☐ TAS can intervene on your behalf
☐ TAS can issue Taxpayer Assistance Orders if warranted
☐ Contact TAS: 877-777-4778

Additional Remedies:

Collection Due Process (CDP) Hearing:
If you received a CDP notice (Letter 3172) within the past 30 days, you may request a CDP hearing which includes the right to appeal to Tax Court.

Judicial Review:
Limited judicial review may be available through:
- Tax Court (if CDP rights exist)
- District Court (for certain refund claims)
- Consult with tax attorney regarding litigation options

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SPECIAL SITUATIONS

Business Entities:

• Authorized officer must sign withdrawal request
• Include corporate resolution authorizing signatory (if requested)
• Withdrawal for DDIA limited to income tax liabilities only
• Employment tax liens generally not eligible for DDIA withdrawal

Multiple NFTLs:

• Submit separate Form 12277 for each NFTL, or
• List all NFTLs on single form with attached schedule
• Each NFTL requires separate withdrawal determination

Deceased Taxpayer:

• Personal representative or executor must submit request
• Include Letters Testamentary or Letters of Administration
• Explain estate administration status

Innocent Spouse Claims:

• If pursuing innocent spouse relief, note this in withdrawal request
• Withdrawal may be appropriate pending innocent spouse determination
• Reference Form 8857 filing if applicable

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PRACTITIONER NOTES

For Tax Professionals Submitting on Behalf of Clients:

☐ Valid Form 2848 (Power of Attorney) must be on file with IRS

☐ Verify CAF number is active: [________________________________]

☐ Include copy of Form 2848 with submission

☐ Ensure authorization covers "Federal Tax Lien" matters

☐ Client signature required on Form 12277 unless POA explicitly authorizes

Strategic Considerations:

1. Timing: Submit DDIA withdrawal requests after fourth successful payment to ensure three payments have cleared

2. Documentation: Over-document rather than under-document; incomplete requests cause delays

3. Multiple Grounds: Cite all applicable withdrawal criteria; IRS may approve on alternative ground

4. Third Parties: Identify all creditors and credit bureaus for notification at time of request

5. Preserve Appeal Rights: Meet all deadlines; late appeals waive rights

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DECLARATION

I, [________________________________], declare under penalties of perjury under the laws of the United States of America that the information provided in this withdrawal request and all supporting documentation is true, correct, and complete to the best of my knowledge and belief.

Executed on: [__/__/____]

Taxpayer Signature: _________________________________________

Print Name: [________________________________]

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This template provides general guidance for requesting withdrawal of a Notice of Federal Tax Lien under IRC 6323(j). Tax lien matters involve complex federal procedures and tight deadlines. Consult with a qualified tax attorney or enrolled agent before submitting your request.