Federal Free Printable Form 14457 (Rev. 4-2017) for 2017 Federal Offshore Voluntary Disclosure Letter

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Offshore Voluntary Disclosure Letter
Form 14457 (Rev. 4-2017)

Form Department of the Treasury–Internal Revenue Service 14457 (April 2017) OMB Number 1545-2241 Offshore Voluntary Disclosure Letter If taxpayer has domestic issues only, please have them apply for a traditional voluntary disclosure. Submit Form 14457 to: Internal Revenue Service Voluntary Disclosure Coordinator 1-D04-100 2970 Market Street Philadelphia, PA 19104 To assist in a timely determination of acceptance into the Voluntary Disclosure Program (for Voluntary Disclosures involving offshore accounts), the Taxpayer must address all of the following items. All answers and attachments must be in English. If you filed jointly at any point during the past eight years, your spouse should also apply for the OVDP by answering the questions below. Date 1a. Name Taxpayer 1b. Taxpayer Identification Number Taxpayer 1c. Date of Birth Taxpayer Spouse Spouse Spouse 1d. Address Taxpayer 1e. Telephone number Taxpayer Spouse Spouse 1f. Passport Number(s) Taxpayer 1g. Country(ies) Taxpayer 1h. Current Occupation Taxpayer Spouse Spouse Spouse 1i. Bank Name(s) Taxpayer 1j. Name on Bank Account Taxpayer 1k. Bank Account Number(s) Taxpayer Spouse Spouse Spouse Note: Estates must include a court document or Form 56 verifying who is authorized to sign the Form 2848. 2a. Taxpayer Representative 2b. Phone Number 2c. Address of Taxpayer Representative 3. Type of Voluntary Disclosure Offshore Only Offshore and Domestic 4. How did you learn about the Offshore Voluntary Disclosure Program? 5. Identify the Source of Funds U.S. Wages Foreign Business Income a. Explanation U.S. Business Income Gift/Inheritance Illegal Source Other Foreign Wages 6. Have any of the offshore accounts you are disclosing been identified by the IRS as ineligible for this program? Taxpayer Yes No Spouse Yes No 7. Has anyone, including a foreign government or a foreign financial institution, advised you that your offshore account records, which are the subject of this voluntary disclosure, were susceptible to being turned over to the U.S. Government pursuant to an official request? Taxpayer Yes No Spouse Yes No a. If “Yes,” did you or anyone on your behalf submit documents in opposition? Taxpayer Yes No Yes No Spouse Catalog Number 61637F www.irs.gov Form 14457 (Rev. 4-2017) Page 2 b. If “Yes,” were copies of those documents provided to the Attorney General of the United States as required by 18 USC §3506? Taxpayer Yes No Spouse Yes No 8. Disclose if you or any related entities currently under audit or criminal investigation by the Internal Revenue Service or any other law enforcement authority? a. Has the IRS notified you, your spouse or any related entities that it intends to commence an examination or investigation? Taxpayer Yes No Spouse Yes No Related entities Yes No Yes No Spouse Yes No Related entities Yes No 9. Do you believe that the IRS has obtained information concerning your tax liability? If “Yes,” specify. Yes No 10. During the disclosure period, have you taken a position that you were a bona fide resident of a U.S. territory (e.g., American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, or the U.S. Virgin Islands) or did you file an income tax return with a U.S. territory? If “Yes,” list the territory and tax years. Yes No b. Are you, your spouse or any related entities under criminal investigation by any law enforcement authority? Taxpayer c. If “Yes,” explain. 11. Please check the box to estimate the annual range of the highest aggregate value of your offshore accounts. Highest Aggregate Account/Asset Value Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year $0 to $100,000 $100,000 to $1,000,000 $1,000,000 to $2,500,000 $2,500,000 to $10,000,000 $10,000,000 to $100,000,000 Greater than $100,000,000 a. Please list all of your accounts Catalog Number 61637F www.irs.gov Form 14457 (Rev. 4-2017) Page 3 12. Please check the box to estimate the range of potential total unreported income from the offshore account(s) during each disclosure period. Estimated Total Unreported Income Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year Tax Year $0 to $100,000 $100,000 to $1,000,000 $1,000,000 to $2,500,000 $2,500,000 to $10,000,000 Greater than $10,000,000 a. Please list all of your accounts for which there is unreported income For each foreign financial account of which you have control or are a beneficial owner, complete the attached Form 14454, Attachment to Offshore Voluntary Disclosure Letter. Please ensure all pages of the attachment include your name, the last four digits of your taxpayer identification number, the name of the foreign financial institution, and the account number for which you are responding. To be included with all Forms 14457: By signing this document, I certify that I am willing to continue to cooperate with the Internal Revenue Service, including in assessing my income tax liabilities and making good faith arrangements to pay all taxes, interest, and penalties associated with this voluntary disclosure. Under penalties of perjury, I declare that I have examined this document, all attachments, and accompanying statements, and to the best of my knowledge and belief, they are true, correct, and complete. Signature of Taxpayer Print Name Date Signature of Taxpayer's Spouse Print Name Date Signature must be original (must be mailed), preferably in blue ink. Photocopied, facsimile, or electronic signatures are not acceptable. The power of attorney may not sign the voluntary disclosure letter on behalf of the taxpayers. IRS reserves the right to make further contacts with the taxpayer to clarify his/her submission. Privacy Act and Paperwork Reduction Act Notice We ask for the information on this foreign account or asset statement to carry out the Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This information will be used to determine and collect the correct amount of tax under the terms of the offshore voluntary disclosure program. You are not required to apply for participation in the offshore voluntary disclosure program. If you choose to apply, however, you are required to provide all the information requested on the foreign account or asset statement. You are not required to provide the information requested on a document that is subject to the Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application. Providing false information may subject you to penalties. The time needed to complete and submit the foreign account or asset statement will vary depending on individual circumstances. The estimated average time is: 2 hour. If you have comments concerning the accuracy of this time estimate or suggestions for making the foreign account or asset statement simpler, we would be happy to hear from you. Comments should be sent to the Internal Revenue Service, Attn: IRS Reports Clearance Officer, SE:W:CAR:MP:T:T:SP, Washington, DC 20224. Catalog Number 61637F www.irs.gov Form 14457 (Rev. 4-2017)
Extracted from PDF file 2016-federal-form-14457.pdf, last modified April 2017

More about the Federal Form 14457 Other TY 2016

We last updated the Offshore Voluntary Disclosure Letter in May 2017, so this is the latest version of Form 14457, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 14457 directly from TaxFormFinder. You can print other Federal tax forms here.

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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 14457 from the Internal Revenue Service in May 2017.

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Historical Past-Year Versions of Federal Form 14457

We have a total of two past-year versions of Form 14457 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 14457

Form 14457 (Rev. 4-2017)

Offshore Voluntary Disclosure Letter 2015 Form 14457

Form 14457 (Rev. 7-2014)


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