USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces provided on the front of this form for: • Your name (include spouse’s name if a joint return) and current address; • Your social security number and/or employer identification number (whichever applies to your tax liability); • Your home and work, cell or business telephone numbers; • The complete name, address and phone number of your employer and your financial institution; • The amount you can pay now as a partial payment; • The amount you can pay each month (or the amount determined by IRS personnel); and • The date you prefer to make this payment (This must be the same day for each month, from the 1st to the 28th). We must receive your payment by this date. If you elect the direct debit option, this is the day you want your payment electronically withdrawn from your financial institution account. Review the terms of this agreement. When you’ve completed this agreement form, please sign and date it. Then, return Part 1 to IRS at the address on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms of this agreement By completing and submitting this agreement, you (the taxpayer) agree to the following terms: • This agreement will remain in effect until your liabilities (including penalties and interest) are paid in full, the statutory period for collection has expired, or the agreement is terminated. • You will make each payment so that we (IRS) receive it by the monthly due date stated on the front of this form. If you cannot make a
USE ONLY. This is an estimated Limitation of Administrative Costs Worksheet only and will not be accepted for Official Submission of the
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: RSI “1” no further review AI “0” Not a PPIA RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs Agreement Review Cycle Earliest CSED Check box if pre-assessed modules included Originator’s ID number Originator Code A NOTICE OF FEDERAL TAX LIEN (Check one box below) HAS ALREADY BEEN FILED WILL BE FILED IMMEDIATELY WILL BE FILED WHEN TAX IS ASSESSED MAY BE FILED IF THIS AGREEMENT DEFAULTS NOTE: A NOTICE OF FEDERAL TAX LIEN WILL NOT BE FILED ON ANY PORTION OF YOUR LIABILITY WHICH REPRESENTS AN INDIVIDUAL SHARED RESPONSIBILITY Name Title PAYMENT UNDER THE AFFORDABLE CARE ACT. Agreement examined or approved by (Signature, title, function) Date Catalog Number 16644M xxx.xxx.xxx Form 433-D (Rev. 1-2015)
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review RSI “5” PPIA IMF 2 year review RSI “6” PPIA BMF 2 year review AI “0” Not a PPIA AI “1” Field Asset PPIA AI “2” All other PPIAs HAS ALREADY BEEN FILED WILL BE FILED IMMEDIATELY WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title:
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: A NOTICE OF FEDERAL TAX LIEN (Check one box below.) RSI “1” no further review AI “0” Not a PPIA HAS ALREADY BEEN FILED RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA WILL BE FILED IMMEDIATELY RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs WILL BE FILED WHEN TAX IS ASSESSED Agreement Review Cycle: Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS Check box if pre-assessed modules included Originator’s ID #: Originator Code: Name: Title: Form 433-D (Rev. January 2007) Name and address of taxpayer(s) Department of the Treasury — Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Social security or employer identification number (Taxpayer) (Spouse) Your telephone numbers (including area code)
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: RSI “1” no further review AI “0” Not a PPIA RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs Agreement Review Cycle Earliest CSED Check box if pre-assessed modules included A NOTICE OF FEDERAL TAX LIEN (Check one box below) HAS ALREADY BEEN FILED WILL BE FILED IMMEDIATELY WILL BE FILED WHEN TAX IS ASSESSED MAY BE FILED IF THIS AGREEMENT DEFAULTS NOTE: A NOTICE OF FEDERAL TAX LIEN WILL NOT BE Originator’s ID number Originator Code FILED ON ANY PORTION OF YOUR LIABILITY WHICH Name Title REPRESENTS AN INDIVIDUAL SHARED RESPONSIBILITY
USE ONLY. CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS CONTRACTEE CONTRACTEE’S NAME BY (Authorized Signature) DATE SIGNED(Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS Contractor agrees, as part of the Agreement, to provide to WCI, Inc. the services described in the Agreement and the Attachments to the Agreement, including the services described in Attachment A, Scope of Work and Work Authorization, and in Attachment F, Contractor’s Technical Proposal, (all such services, collectively, the “Work” or the “Work Schedule”), provided, however, that Contractor shall not commence any Work unless expressly authorized by WCI, Inc. in writing to begin performing such Work. This Agreement may be extended and Contractor may be engaged for additional Work, only by mutual agreement of the parties in writing. The cost of the extension or additional Work must be mutually agreed to by WCI, Inc. and the Contractor based on the scope of work of the requested services. Project Representatives are responsible for administrative and financial oversight and accountability. The Contractor Project Representative has the authority to make executive level administrative decisions for the Contractor and any subcontractor(s). The Project Representatives during the term of this Agreement will be: Western Climate Initiative, Inc. Contractor: Name: Name: Phone Phone: Fax: Fax: Email: Email: Direct all administrative inquiries to: Western Climate Initiative, Inc. Contractor: Attention: Attention: Phone: Phone: Fax: Fax: Email: Email: Purpose / Background / Overview A. Purpose [To be completed once Contractor’s services are identified.]
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: Originator’s ID #: Originator Code: Name: Title: RSI “1” no further review AI “0” Not a PPIA RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs Agreement Review Cycle: Earliest CSED: Check box if pre-assessed modules included A NOTICE OF FEDERAL TAX LIEN (Check one box.) HAS ALREADY BEEN FILED WILL BE FILED IMMEDIATELY WILL BE FILED WHEN TAX IS ASSESSED MAY BE FILED IF THIS AGREEMENT DEFAULTS reinstatement fee if we reinstate the agreement. We have the • We may terminate this agreement at any time if we find that collection of the tax is in jeopardy. • This agreement may require managerial approval. We'll notify you FOR IRS USE ONLY: when we approve or don’t approve the agreement.
USE ONLY. AGREEMENT LOCATOR NUMBER: Check the appropriate boxes: RSI “1” no further review AI “0” Not a PPIA RSI “5” PPIA IMF 2 year review AI “1” Field Asset PPIA RSI “6” PPIA BMF 2 year review AI “2” All other PPIAs Agreement Review Cycle Earliest CSED Check box if pre-assessed modules included Originator’s ID number Originator Code Name Title A NOTICE OF FEDERAL TAX LIEN (Check one box below) HAS ALREADY BEEN FILED WILL BE FILED IMMEDIATELY WILL BE FILED WHEN TAX IS ASSESSED MAY BE FILED IF THIS AGREEMENT DEFAULTS Catalog Number 16644M xxx.xxx.xxx Form 433-D (Rev. 11-2013)
USE ONLY. Tenant shall not conduct any business on or about the Premises. Tenant shall not store any materials on or about the Premises which relate to anything commercial or which relate to a hobby that is inconsistent with residential standards.
