Form A 771 – Fill Out and Use This PDF

The A-771 form is a crucial document for residents of Wisconsin looking to set up an installment agreement with the Department of Revenue to manage outstanding tax debts. It outlines the terms for installment payments, including a required processing fee, and mandates accurate disclosure of individual and spouse information, financial assets, expenses, and income. If you're facing financial difficulty and seeking a structured payment plan for tax liabilities, completing this form is the first step toward achieving financial stability. Click the button below to get started on filling out your A-771 form today.

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Form A 771 PDF Details

Navigating through financial difficulties can be overwhelming, especially when it involves dealing with tax liabilities. Fortunately, for residents of Wisconsin facing such challenges, the State's Department of Revenue offers a lifeline in the form of the A-771 form. This document serves as a request for an installment agreement, allowing individuals to propose a plan to settle their tax obligations over time, rather than in a single, potentially unmanageable sum. Complete with sections for personal and spouse information, detailed income and expense declarations, and proposed payment structures, the A-771 form is designed to assess the taxpayer's financial situation comprehensively. Importantly, it also outlines the terms of the agreement, including a processing fee, the impact on credit ratings due to filing tax warrants, and the state's right to void the agreement if false information is provided or there's a significant financial status change. Additionally, the form clearly states that tax refunds will be applied to the outstanding liability, not counted as installment payments, emphasizing the seriousness with which this agreement is treated. Completing both sides of this form with accurate and truthful information is crucial for entering into a negotiation with the Department, offering a structured path towards financial stability for those drowning in tax debt.

Question	Answer
Form Name	Form A 771
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	a 771f how to fill patiala account opening form

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STATE OF WISCONSIN  DEPARTMENT OF REVENUE

2135 RIMROCK ROAD  PO BOX 8901  MADISON WI 53708-8901  Phone (608) 266-7879  FAX (608) 261-8978  delnqtax@revenue.wi.gov

Installment Agreement Request – Processing Fee Required

The department will inform you if your installment request is approved or if additional information is needed. If approved as proposed, an installment agreement will be forwarded to you. If it is determined that larger payments are necessary or additional information is required, someone from the department will contact you. Be sure to complete both sides of this form.

YOUR INFORMATION

Name

Social Security Number

Date of Birth

Address

City, State, Zip
Phone (	)

Name(s) and ages of dependent(s)

Place of Employment

Company

Address

City, State, Zip
City, State, Zip
Phone (	)
Phone (	)
Job Title /Position
Job Title /Position
Gross Income
Gross Income
Net Income		Weekly		Bi-weekly	Monthly
Other Income			$
Other Income
General Assistance			$
General Assistance			$
AFDC			$
Social Security /SSI			$
Social Security /SSI			$
Other (specify)			$
Other (specify)			$

SPOUSE INFORMATION

Name

Social Security Number

Date of Birth

Address

City, State, Zip
Phone (	)

Name(s) and ages of dependent(s)

Place of Employment

Company

Address

City, State, Zip
City, State, Zip
Phone (	)
Phone (	)
Job Title /Position
Job Title /Position
Gross Income
Gross Income
Net Income		Weekly		Bi-weekly	Monthly
Other Income			$
Other Income
General Assistance			$
General Assistance			$
AFDC			$
Social Security /SSI			$
Social Security /SSI			$
Other (specify)			$
Other (specify)			$

PROPOSED INSTALLMENT AGREEMENT

/ /

(mo/day/yr)

{	Monthly OR	Semi-monthly	Bi-weekly	Weekly
	Monthly Automatic Withdrawal		(check withdrawal date)	
 First Payment / Withdrawal Date

5th

15th

25th

INSTALLMENT AGREEMENT TERMS:

1.A $20.00 fee will be added to your balance when an installment agreement is accepted by the department.

2.An installment agreement will not prevent the iling of a delinquent tax warrant. These warrants are liens against your property and, as public records, may affect your credit rating. The iling of these tax warrants will add additional charges to your balance.

3.Your Wisconsin and Federal tax refunds will be used to reduce the unpaid tax liability and will not be considered installment payments on your agree- ment.

4.All returns and taxes must be iled and paid as they become due.

5.The Wisconsin Department of Revenue reserves the right to void any agreement if it is determined that it was made based on false or inaccurate infor- mation or if there is a material change in your inancial condition.

I/ We have read and understand the terms listed above and wish to enter into an installment agreement with the Wisconsin Department of Revenue. I/ We also attest that the information furnished on this form is true and correct to the best of my/our knowledge.

Your Signature

Date

Spouse Signature

Date

A-771 (R. 4-12)

Please indicate both separate and combined assets and expenses.

Financial Institutions	Balance		Name and address of institution
Checking Account	$
Savings Account	$
Other (IRA, CD,	$
Money Market, etc.)
Life Insurance Policies				Cash	Balance Due
Company		Beneiciary	Amount	Value	on Loan
			$	$	$
			$	$	$
			$	$	$

Yes

No	Have premiums been paid to date?

Motor Vehicles
Make			Model			Year	Fair Market Value $				Balance Due $
License Plate #				Lien Holder					Address
Make			Model			Year	Fair Market Value $				Balance Due $
License Plate #				Lien Holder					Address
Other personal property (boat, motorcycle, snowmobile, etc.):
Real Estate (If you rent, list name and address of landlord)
Location							Fair Market Value $				Balance Due $
Mortgage Holder							Address
Expenses						Monthly				Please note any payments you
						Payment		Balance Due		are behind in and by how much
Mortgage or Rent					$		$
Mortgage or Rent					$		$
Property tax escrow					$		$
Property tax escrow					$		$
Auto payments					$		$
Auto payments					$		$
Gasoline/oil					$		$
Gasoline/oil					$		$
Utilities: Home Heating					$		$
Utilities: Home Heating					$		$
	Electrical				$		$
	Telephone				$		$
	Telephone				$		$
	Water				$		$
	Water				$		$
	Cable / internet access				$		$
	Cable / internet access				$		$
Loans (list)		1.			$		$
Loans (list)		1.			$		$
		2.			$		$
		2.			$		$
		3.			$		$
		3.			$		$
Credit Cards		. . . . . . . . . Is card still in use?
VISA			No	Yes	$		$
VISA			No	Yes	$		$
MasterCard			No	Yes	$		$
MasterCard			No	Yes	$		$
Discover			No	Yes	$		$
Other:			No	Yes	$		$
Other:			No	Yes	$		$
Food					$		$
Food					$		$
Entertainment					$		$
Insurance (all)					$		$
Insurance (all)					$		$
IRS – Delinquent Payment					$		$
IRS – Delinquent Payment					$		$
Other (list)					$		$

Total Monthly Expenses. . . . . . . . . . . . . . . . . . . .$

Total Net Monthly Income . . . . . . . . . . . . . . . . . .$

Net Difference . . . . . . . . . . . . . . . . . . . . . . . . . . .$

How to Edit Form A 771 Online for Free

Whenever you need to fill out Form A 771, there's no need to download any programs - simply make use of our PDF tool. To keep our tool on the cutting edge of practicality, we work to put into operation user-driven capabilities and improvements on a regular basis. We're routinely thankful for any feedback - join us in reshaping PDF editing. With just a couple of easy steps, you'll be able to start your PDF journey:

Step 1: Click on the "Get Form" button above on this page to get into our PDF tool.

Step 2: The editor will let you modify your PDF form in various ways. Transform it by including customized text, adjust what is already in the PDF, and add a signature - all within a few mouse clicks!

This PDF form requires particular details to be typed in, therefore be certain to take the time to type in exactly what is requested:

1. Fill out your Form A 771 with a group of essential blanks. Consider all the important information and ensure there is nothing forgotten!

2. The subsequent stage would be to fill in these particular blank fields: Other Income General Assistance, Other Income General Assistance, PROPOSED INSTALLMENT AGREEMENT, modayyr, Monthly, Semimonthly, Biweekly, Weekly, Monthly Automatic Withdrawal check, First Payment Withdrawal Date, INSTALLMENT AGREEMENT TERMS A, may affect your credit rating The, Your Wisconsin and Federal tax, ment, and All returns and taxes must be.

3. This next step should be quite simple, Financial Institutions, Balance, Name and address of institution, Checking Account Savings Account, Beneiciary, Amount, Cash Value, Balance Due, on Loan, Yes, Have premiums been paid to date, Motor Vehicles, Make License Plate, Make License Plate, and Model - these blanks will need to be filled out here.

Form A 771 completion process clarified (stage 3)

4. This section arrives with the next few blank fields to complete: Real Estate If you rent list name, Location Mortgage Holder, Expenses, Fair Market Value Address, Balance Due, Monthly Payment, Balance Due, Please note any payments you are, Yes Yes Yes Yes, Electrical Telephone Water Cable, and Mortgage or Rent Property tax.

Find out how to complete Form A 771 part 4

Lots of people frequently make some errors when filling out Location Mortgage Holder in this section. Ensure you reread what you enter right here.

5. The pdf needs to be wrapped up by dealing with this area. Further you will see an extensive set of form fields that need appropriate details to allow your document usage to be complete: Mortgage or Rent Property tax, and Net Difference.

Net Difference, Net Difference, and Net Difference inside Form A 771

Step 3: Ensure the information is right and then click on "Done" to complete the task. Join FormsPal now and instantly obtain Form A 771, all set for downloading. All modifications you make are saved , enabling you to modify the pdf further if necessary. At FormsPal, we strive to make certain that all your details are maintained private.

Form A 771 – Fill Out and Use This PDF

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