Form 4180 Pdf PDF Details

The Form 4180, provided by the Department of the Treasury - Internal Revenue Service, serves as a critical tool in determining an individual's responsibility and liability concerning trust fund recovery penalties or personal liability for excise taxes. Designed to document the outcomes of interviews conducted either in person or via telephone, this form is meticulous in its approach to gathering comprehensive data. Interviewees are required to fill in detailed sections, including personal information such as name, Social Security Number, and contact details, alongside probing questions on their relationship and duties within a business. It delves into financial policy roles, authorization of payments, knowledge and involvement in tax matters, and specifics regarding third-party payers like payroll services. Moreover, the form addresses the issue of willfulness and knowledge concerning unpaid taxes, asking about actions taken once the unpaid taxes were acknowledged. Also, it extends to cover scenarios involving payroll service providers or professional employer organizations, focusing on contractual relationships and tax payment verifications. The seriousness of these investigations is underscored by the need for complete honesty, as indicated by the declaration signatures required at the document's end. Furthermore, the inclusion of notices about privacy and personal liability for certain unpaid federal taxes serves as a reminder of the legal implications tied to these matters. Form 4180 thus stands as a vital document for both the IRS and those interviewed, aiming to clarify responsibilities and pave the way towards resolving tax disputes.

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Form NameForm 4180 Pdf
Form Length4 pages
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Avg. time to fill out1 min
Other namesform report trust, irs 4180, 4180 irs, 4180 form

Form Preview Example

Form 4180

(August 2012)

Department of the Treasury - Internal Revenue Service

Report of Interview with Individual Relative to Trust Fund Recovery

Penalty or Personal Liability for Excise Taxes

Instructions: The interviewer must prepare this form either in person or via telephone.

Do not leave any information blank. Enter ''N/A'' if an item is not applicable.

Section I - Person Interviewed

1.

Name

2.

Social Security Number (SSN)

 

 

 

 

3.

Address (street, city, state, ZIP code)

4.

Home telephone number

 

 

 

(

)

 

 

 

 

 

 

5.

Work telephone number

 

 

 

(

)

 

 

 

 

 

6. Name of Business and Employer Identification Number (EIN)

7. Did you use a third-party payer, such as a payroll service?

Yes (If yes complete Section VI A)

No

8.What was your job title and how were you associated with the business? (Describe your duties and responsibilities and dates of employment.) If person being interviewed is a payroll service provider or a professional employer organization, complete Section VI B

Section II - Responsibilities

1.State whether you performed any of the duties / functions listed below for the business and the time periods during which you performed these duties.

Did you...

 

 

Yes

No

 

Dates

 

 

From

 

To

 

 

 

 

 

 

a. Determine financial policy for the business?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. Direct or authorize payments of bills/creditors?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. Prepare, review, sign, or authorize transmit payroll tax returns?

 

 

 

 

 

 

 

 

 

 

 

 

 

d. Have knowledge withheld taxes were not paid?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. Authorize payroll?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f. Authorize or make Federal Tax Deposits?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g. Authorize the assignment of any EFTPS or electronic banking PINS/passwords?

 

 

 

 

 

 

 

 

 

 

 

 

h. Could other individuals do any of the above? (Complete Section IV and V)

 

 

 

 

 

Name

 

Contact Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i. Have signature authority or PIN assignment on business bank accounts?

 

 

 

 

 

Bank Name(s)

 

Account Number(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section III - Signatures

I declare that I have examined the information given in this interview and to the best of my knowledge and belief, it is true, correct, and complete.

Signature of person interviewed

Signature of Interviewer

Date

Date

Date copy of completed interview form given to person interviewed

Taxpayer Statement on Page 4:

Yes

No

Interview Continued on subsequent pages?

Yes

No

Interview Handouts (''X'' if given or explain why not in case history.)

Notice 609, Privacy Act Notice

Notice 784, Could You be Personally Liable for Certain Unpaid Federal Taxes?

Catalog Number 22710P

www.irs.gov

Form 4180 (Rev. 8-2012)

Page 2

Section IV - Business Information

1. List corporate positions below, identifying the persons who occupied them and their dates of service.

Position (e.g. president, director)

Name

Address

Dates

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Did/does the business use the Electronic Federal Tax Payment

3. Other than the EFTPS, does the business do any other banking

System (EFTPS) to make Federal Tax Deposits (FTD's) or

electronically?

payments?

No

 

No

Yes Where

Yes If yes, to whom are the PINS or passwords assigned

 

 

To whom are the PINs/passwords assigned

4. Does the business file Form 941 electronically?

No

Who is authorized to sign Form 941

Yes

Who files the returns electronically

Section V - Knowledge / Willfulness

1.During the time the delinquent taxes were increasing, or at any time thereafter, were any financial obligations of the business paid?

(such as rent, mortgage, utilities, vehicle or equipment loans, or payments to vendors)

No

Yes Which obligations were paid?

Who authorized them to be paid?

2. Were all or a portion of the payrolls met?

No

Yes

Who authorized

3.Did any person or organization provide funds to pay net corporate payroll?

No

Yes (explain in detail and provide name)

4. When and how did you first become aware of the unpaid taxes? 5. What actions did you attempt to see that the taxes were paid?

6. Were discussions ever held by stockholders, officers, or other

7. Who handled IRS contacts such as phone calls,

interested parties regarding nonpayment of the taxes?

correspondence, or visits by IRS personnel?

No

 

Yes

 

Identify who attended, dates, any decisions reached, and

When did these contacts take place, and what were the results

whether any documentation is available.

of these contacts?

Catalog Number 22710P

www.irs.gov

Form 4180 (Rev. 8-2012)

Page 3

Section VI - Payroll Service Provider (PSP) or Professional Employer Organization (PEO)

A - Third-Party Payer Arrangements

(complete this section only if you are interviewing a taxpayer who used a third-party payer)

1.

Who signed the service contract or entered into the agreement

2. Who in the business handled the contacts with the third-party

 

for services with the third-party payer?

 

payer?

 

 

 

 

 

3.

Who was your contact at the third-party payer?

4. How were funds to be made available for the third-party payer to

 

 

pay the taxes?

 

 

 

 

 

 

 

Name of Bank(s) and Account number(s) from which funds

 

 

 

were to be transferred.

 

 

 

5.

What actions did you take to verify the third-party payer was

6. Were funds available for the third-party payer to use for

 

filing returns, or making required payments?

 

payment of the taxes?

 

 

 

Yes

No

 

 

 

If yes, explain in detail how and when the money was

 

 

 

transferred to the third-party.

7. Were you aware that the third-party payer was not making the

8. Did you receive IRS notices indicating that the employment tax

required payments?

returns were not filed, or that the employment taxes were not

 

 

paid?

 

Yes

No

Yes

No

B - Third-Party Payer Companies

(complete this section only if you are interviewing a Third-Party Payroll Service Payer)

1.

Who in your organization handled the contacts with the client?

2.

Who was your contact at the client business?

 

 

 

 

3.

Who at the client business signed the service contract or

4.

Who had control over the payments of the client's employment

 

entered into the agreement for services?

 

taxes?

 

 

 

 

5. How were funds to be made available from the client business to pay the taxes?

Bank Name(s)

Account Number(s)

6. Were there funds actually available for you to make the tax payments?

Yes

No

If yes, explain in detail how and when the money was transferred to the third-party.

If no, what actions did you take to attempt to collect the funds from the client?

Section VII - Personal Liability for Excise Tax Cases (Complete only if Business is required to file Excise Tax Returns)

1.

Are you aware of any required excise tax returns which have not

2. With respect to excise taxes, were the patrons or customers

 

been filed?

 

informed that the tax was included in the sales price?

 

No

Yes (list periods)

No

Yes

 

 

 

3.

If the liability is one of the ''collected'' taxes (transportation of

4. Were you aware, during the period tax accrued, that the law

 

persons or property and communications), was the tax

required collection of the tax?

 

collected?

 

 

 

 

No

Yes

No

Yes

 

 

 

 

 

Catalog Number 22710P

www.irs.gov

Form 4180 (Rev. 8-2012)

Page 4

Additional Information

Section VIII - Signatures

I declare that I have examined the information given in this interview and to the best of my knowledge and belief, it is true, correct, and complete.

Signature of person interviewed

 

Date

 

 

 

Signature of Interviewer

 

Date

 

 

 

Date copy of completed interview form given to person interviewed

 

 

 

 

Interview Handouts (''X'' if given or explain why not in case history.)

Notice 609, Privacy Act Notice

Notice 784, Could You be Personally Liable for Certain Unpaid Federal Taxes?

Catalog Number 22710P

www.irs.gov

Form 4180 (Rev. 8-2012)

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4180 irs empty fields to fill out

Type in the details in the e Authorize payroll, f Authorize or make Federal Tax, g Authorize the assignment of any, h Could other individuals do any, Name, Contact Number, i Have signature authority or PIN, Bank Names, Account Numbers, Section III Signatures, I declare that I have examined the, Signature of person interviewed, Signature of Interviewer, Date, and Date field.

4180 irs e Authorize payroll, f Authorize or make Federal Tax, g Authorize the assignment of any, h Could other individuals do any, Name, Contact Number, i Have signature authority or PIN, Bank Names, Account Numbers, Section III  Signatures, I declare that I have examined the, Signature of person interviewed, Signature of Interviewer, Date, and Date blanks to insert

You will have to provide particular particulars inside the field Position eg president director, Name, Address, Dates, Diddoes the business use the, Other than the EFTPS does the, electronically, Yes Where, If yes to whom are the PINS or, To whom are the PINspasswords, Yes, Does the business file Form, Yes, Who is authorized to sign Form, and Who files the returns.

4180 irs Position eg president director, Name, Address, Dates, Diddoes the business use the, Other than the EFTPS does the, electronically, Yes Where, If yes to whom are the PINS or, To whom are the PINspasswords, Yes, Does the business file Form, Yes, Who is authorized to sign Form, and Who files the returns fields to insert

Identify the rights and responsibilities of the parties inside the box Yes Which obligations were paid, Who authorized them to be paid, Were all or a portion of the, Did any person or organization, Yes, Who authorized, Yes explain in detail and provide, When and how did you first become, Were discussions ever held by, interested parties regarding, Who handled IRS contacts such as, and Yes.

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