×
tax forms found in
Tax Form Code
Tax Form Name

Federal Free Printable Form 13656 (3-2005) for 2019 Federal Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative

It appears you don't have a PDF plugin for this browser. Please use the link below to download 2018-federal-form-13656.pdf, and you can print it directly from your computer.

Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative
Form 13656 (3-2005)

Department of the Treasury — Internal Revenue Service Form 13656 Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative (March 2005) NOTE: The Service can decline to execute a closing agreement with any party that fails to provide all information requested within this Form 13656. Section I. Executive Information 1. Executive name (and name of spouse, if joint return) 2. Social security number (SSN) 3. Address (Street, City, State, ZIP code) (Executive) – – (Spouse) – – 4. Daytime telephone number ( ) 5. FAX number ( ) 6. Executive currently is in Appeals or Examination Yes (Please complete items 8 and 9.) 7. Executive has executed a Power of Attorney No Yes (Please attach a copy.) 8. Name and address (Street, City, State, ZIP code) of Appeals Officer or Agent No 9. Daytime telephone number ( ) I elect to participate in the settlement initiative as described in Announcement 2005-19 and as contained in Internal Revenue Bulletin 2005-11 dated March 14, 2005. I am submitting with this election the information and documents requested. Under penalties of perjury, I declare that I have examined this Form 13656 and to the best of my knowledge and belief, it is true, correct and complete. Executive Attestation Signature of Executive Section II. Date Related Person Information 1. Name of Related Person to which stock options or restricted stock were transferred 2. Related Person identification number (EIN) 3. Address (Street, City, State, ZIP code) 4. Daytime telephone number ( ) 5. FAX number ( ) 6. Related Person has executed a Power of Attorney Catalog No. 39565K Sheet 1 of 4 Yes (Please attach a copy.) www.irs.gov No Form 13656 (3-2005) Section II. Related Person Information — continued Related Person Attestation All partners/members of the Related Person elect to participate in the settlement initiative as described in Announcement 2005-19 and as contained in Internal Revenue Bulletin 2005-11 dated March 14, 2005. Under penalties of perjury, I declare that I have examined this Form 13656 and to the best of my knowledge and belief, it is true, correct and complete. 1. 2. 3. 4. 5. 6. 7. 8. Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Name (Please print.) Signature Date Section III. Corporation Information 1. Name of corporation that issued the stock options or restricted stock 2. Corporation identification number (EIN) 3. Address (Street, City, State, ZIP code) 4. Daytime telephone number ( ) 5. FAX number ( ) 6. Is the corporation electing to participate in this settlement initiative? Yes 7. Name of corporation that received the services from the Executive (if different from the corporation named in Section III, Item 1) No Unknown 8. Corporation identification number (EIN) 10. Daytime telephone number ( ) 9. Address (Street, City, State, ZIP code) 11. FAX number ( ) Form 13656 (3-2005) Catalog No. 39565K Sheet 2 of 4 www.irs.gov Department of the Treasury – Internal Revenue Service Section IV. Information and Documentation Required to Process Election by Executive and Related Person Answer the following questions and provide the listed documentation. If you need additional space for your answers, please attach additional sheets and identify the continued answers by item number. “Provide documentation” means “Attach copies of documents that verify your responses.” 1. What did the Related Person transfer to the Executive in exchange for the stock options or restricted stock the Executive transferred to the Related Person? On what date(s) did the transfer or sale occur? Provide documentation (including copies of any promissory notes and appraisal reports). 2. On what date(s) did the Related Person exercise stock options it received from the Executive? Does the Related Person still hold Yes No (Or, on what date did the restricted stock vest?) options it has not exercised? What was the fair market value of the stock on the exercise date or the date of vesting? Provide documentation. 3. Has the Related Person paid any amounts (including interest) to the Executive? 4. Did the Related Person or the Executive pay any transaction costs (including promoter, accounting, appraisal, and legal fees)? Yes (Provide documentation of all payments.) Yes (Provide documentation of all payments.) No No 5. Has the Related Person sold all the stock it acquired through this transaction (including stock acquired by exercising options)? Yes (See below.) No Note: For any stock sold, provide a schedule listing the number of shares sold, the date of sale, the sales price, and the claimed basis at the date of sale. Provide documentation. 6. Provide copies of all promotional packages, legal opinions, or engagement letters obtained by the Executive or the Related Person (or any person acting on their behalf) pertaining to this transaction. 7. Provide the name, address, and telephone number of the entity and person(s) that sold or promoted the sale of the transaction described in Announcement 2005-19 to the Executive or the Related Person. 8. Provide a computation of any tax and penalty due from the Executive under the terms of Announcement 2005-19. 9. Provide a computation of the Related Person's basis in stock still held pursuant to Announcement 2005-19. Form 13656 (3-2005) Catalog No. 39565K Sheet 3 of 4 www.irs.gov Department of the Treasury – Internal Revenue Service Information and Documentation Required to Process Election by Executive and Related Person Section IV. — continued 10. Provide a computation of any change in the tax liability of the Related Person as a result of this Election. 11. Is the Executive or Related Person currently in tax litigation with the government? Yes (Provide a copy of the complaint No or the Tax Court petition.) 13. Provide a schedule listing the names, addresses, and SSNs of the following: 12. Provide copies of all federal tax returns filed by the Related Person and the Executive from the date the options or restricted stock was transferred to the Related Person to the present. 14. Has the Executive filed a Qualified Amended Return (as defined by Treas. Reg. §1.6664-2(c)(3)) pertaining to the transaction? a. All partners or members of the Related Person and Yes (Provide a copy.) b. The spouses of partners or other members of passthrough entities who filed joint returns for any taxable period affected by the terms of the settlement. 15. Has the Executive filed a disclosure statement pertaining to the transaction pursuant to Announcement 2002-2? Yes (Provide a copy.) No 16. Has the Executive or the Related Person received a Form W-2 or Form 1099 pertaining to the transaction? No Yes (Provide a copy of all forms.) No Instructions 1. Send your completed Form 13656 to: Internal Revenue Service ATTN: Announcement 2005-19 MC 4166 NWSAT 4050 Alpha Road Farmers Branch, TX 75244 2. If you are under examination or in Appeals, please provide a copy of this Notice of Election to the examining revenue agent or the Appeals Officer. Form 13656 (3-2005) Catalog No. 39565K Sheet 4 of 4 www.irs.gov Department of the Treasury – Internal Revenue Service
Extracted from PDF file 2018-federal-form-13656.pdf, last modified February 2005

More about the Federal Form 13656 Other TY 2018

We last updated the Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative in February 2019, so this is the latest version of Form 13656, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 13656 directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Other Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 8962 Premium Tax Credit
Form W-4V Voluntary Withholding Request
Form W-4 Employee's Withholding Allowance Certificate
Form 8840 Closer Connection Exception Statement for Aliens
Form 8965 Health Coverage Exemptions

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 13656 from the Internal Revenue Service in February 2019.

Show Sources >

Historical Past-Year Versions of Federal Form 13656

We have a total of six past-year versions of Form 13656 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 13656

Form 13656 (3-2005)

2017 Form 13656

Form 13656 (3-2005)

2016 Form 13656

Form 13656 (3-2005)

Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative 2015 Form 13656

Form 13656 (3-2005)

Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative 2012 Form 13656

Form 13656 (3-2005)

Notice of Election by Executive and Related Person to Participate in Announcement 2005-19 Settlement Initiative 2011 Form 13656

Form 13656 (3-2005)


TaxFormFinder Disclaimer:

While we do our best to keep our list of Federal Income Tax Forms up to date and complete, we cannot be held liable for errors or omissions. Is the form on this page out-of-date or not working? Please let us know and we will fix it ASAP.

** This Document Provided By TaxFormFinder.org **
Source: http://www.taxformfinder.org/federal/form-13656