Form A 771 PDF Details

Are you familiar with the Form 771? It's a form used to request an extension of time to file your income tax return. This form can be used if you need more time to gather the information needed to complete your return, or if you're waiting for a refund from a previous year's return. The extension gives taxpayers until October 15th to file their returns. Note that this is not an extension of time to pay any taxes owed - those are still due on April 15th. So, if you think you might owe money and don't want to risk incurring penalties and interest, it's best to submit your payment along with your extension request. You can find Form 771 on the IRS website at irs.gov. If you're like most taxpayers, you probably wait until the last minute to submit your income tax returns. But what do you do if you realize that you won't be able to meet the April 15th deadline? Don't worry - you can apply for an extension of time to file your return. The form for requesting an extension is known as For

QuestionAnswer
Form NameForm A 771
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesa 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone (

)

 

 

 

 

 

 

 

 

 

 

 

 

Job Title /Position

 

 

 

 

 

 

 

 

 

 

Gross Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net Income

 

 

 

Weekly

 

Bi-weekly

Monthly

Other Income

 

 

 

 

$

 

 

 

 

 

 

 

 

 

General Assistance

 

$

 

 

 

 

 

AFDC

 

 

 

 

$

 

 

Social Security /SSI

 

$

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone (

)

 

 

 

 

 

 

 

 

 

 

 

 

Job Title /Position

 

 

 

 

 

 

 

 

 

 

Gross Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net Income

 

 

 

Weekly

 

Bi-weekly

Monthly

Other Income

 

 

 

 

$

 

 

 

 

 

 

 

 

 

General Assistance

 

$

 

 

 

 

 

AFDC

 

 

 

 

$

 

 

Social Security /SSI

 

$

 

 

 

 

 

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

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Property tax escrow

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Auto payments

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gasoline/oil

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Utilities: Home Heating

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electrical

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

Telephone

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cable / internet access

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Loans (list)

1.

 

 

 

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Cards

. . . . . . . . . Is card still in use?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VISA

No

Yes

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MasterCard

No

Yes

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discover

No

Yes

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

No

Yes

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Food

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entertainment

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Insurance (all)

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IRS – Delinquent Payment

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other (list)

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

$

 

 

 

 

 

 

 

 

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

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

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

How to Edit Form A 771 Online for Free

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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!

Completing part 1 in Form A 771

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.

Writing part 2 of Form A 771

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.

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