Common use of USE ONLY Clause in Contracts

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 If you elect the direct debit option, this is the day you want your payment electronically withdrawn from your financial institution account.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. 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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Originator Code: Name: Title: 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) Part 2 — Taxpayer’s Copy 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 receive a notice from us prior to termination of your agreement. • 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 aa scheduled payment, contact us immediately. • This agreement is based on your current financial condition. We may modify or terminate the agreement if our information shows that your ability to pay has significantly changed. You must provide updated financial information when requested. • While this agreement is in effect, you must file all federal tax returns and pay any (federal) taxes you owe on time. • We will apply your federal tax refunds or overpayments (if any) to the entire amount you owe, including the shared responsibility payment under the Affordable Care Act, until it is fully paid or the statutory period for collection has expired. • You must pay a $120 user fee, which we have authority to deduct from your first payment(s) ($52 for Direct Debit). You may be eligible for a reduced user fee of $43. See Form 13844 for qualifications and instructions. • If you default on your installment agreement, you must pay a $50 reinstatement fee if we reinstate the agreement. We have the authority to deduct this fee from your first payment(s) after the agreement is reinstated. • We will apply all payments on this agreement in the best interests of the United States. Generally we will apply the payment to the oldest collection statute, which is normally the oldest tax year or period. • We can terminate your installment agreement if: • You do not make monthly installment payments as agreed. You do not pay any other federal tax debt when due. You do not provide financial information when requested. • If we terminate your agreement, we may collect the entire amount you owe, EXCEPT the Individual Shared Responsibility Payment under the Affordable Care Act, by levy on your income, bank accounts or other assets, or by seizing your property. • 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 when we approve or don’t approve the agreement. • We may file a Notice of Federal Tax Lien if one has not been filed previously which, may negatively impact your credit rating, but we will not file a Notice of Federal Tax Lien with respect to the individual shared responsibility payment under the Affordable Care Act. HOW TO PAY BY DIRECT DEBIT Instead of sending us a check, you can pay by direct debit (electronic withdrawal) from your checking account at a financial institution (such as a bank, mutual fund, brokerage firm, or credit union). To do so, fill in Lines a and b. Contact your financial institution to make sure that a direct debit is allowed and to get the correct routing and account numbers.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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) Part 2 — Financial Institution Copy (Direct Debit only) Kinds of taxes (Form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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 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. 7-2020) Part 1 — IRS Copy I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form for: • Your name (include spouse’s name if a joint return) page. Please review them thoroughly. By initialing here and current address; • Your social security number and/or employer identification number (whichever applies my signature below, I agree 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 , as provided in this agreement form, please sign and date itif it is approved by the Internal Revenue Service. 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. Additional Conditions / Terms of this agreement (To be completed by IRS) By completing signing and submitting this agreementform, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process and administer this agreement over its duration. DIRECT DEBIT — Attach a voided check or complete this part only if you (choose to make payments by direct debit. Read 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 instructions on the front back of this form. If you cannot make apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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 PAYMENT UNDER THE AFFORDABLE CARE ACT. I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form for: • Your name (include spouse’s name if a joint return) page. Please review them thoroughly. By initialing here and current address; • Your social security number and/or employer identification number (whichever applies my signature below, I agree 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 , as provided in this agreement form, please sign and date itif it is approved by the Internal Revenue Service. 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. Additional Conditions / Terms of this agreement (To be completed by IRS) By completing signing and submitting this agreementform, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process and administer this agreement over its duration. DIRECT DEBIT — Attach a voided check or complete this part only if you (choose to make payments by direct debit. Read 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 instructions on the front back of this form. If you cannot make apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS CSED Check box if pre-assessed modules included Originator’s ID #: number Originator Code: Name: Title: 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) Part 3 — Taxpayer’s Copy 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 receive a notice from us prior to termination of your agreement. • 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 aa scheduled payment, contact us immediately. • This agreement is based on your current financial condition. We may modify or terminate the agreement if our information shows that your ability to pay has significantly changed. You must provide updated financial information when requested. • While this agreement is in effect, you must file all federal tax returns and pay any (federal) taxes you owe on time. • We will apply your federal tax refunds or overpayments (if any) to the amount you owe until it is fully paid or the statutory period for collection has expired. • You must pay a $120 user fee, which we have authority to deduct from your first payment(s) ($52 for Direct Debit). • If you default on your installment agreement, you must pay a $50 reinstatement fee if we reinstate the agreement. We have the authority to deduct this fee from your first payment(s) after the agreement is reinstated. • We will apply all payments on this agreement in the best interests of the United States. Generally we will apply the payment to the oldest collection statute, which is normally the oldest tax year or period. • We can terminate your installment agreement if: • You do not make monthly installment payments as agreed. • You do not pay any other federal tax debt when due. • You do not provide financial information when requested. • If we terminate your agreement, we may collect the entire amount you owe by levy on your income, bank accounts or other assets, or by seizing your property. • 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 when we approve or don’t approve the agreement. • We may file a Notice of Federal Tax Lien if one has not been filed previously which may negatively impact your credit rating. HOW TO PAY BY DIRECT DEBIT Instead of sending us a check, you can pay by direct debit (electronic withdrawal) from your checking account at a financial institution (such as a bank, mutual fund, brokerage firm, or credit union). To do so, fill in Lines a and b. Contact your financial institution to make sure that a direct debit is allowed and to get the correct routing and account numbers.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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 Kinds of taxes (Form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Originator 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) Part 1 — IRS Copy Form 433-D (Rev. January 2015) Department of the Treasury - Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Name and address of taxpayer(s) Social Security or Employer Identification Number (SSN/EIN) (Taxpayer) (Spouse) Your telephone numbers (including area code) (Home) (Work, cell or business) For assistance, call: 0-000-000-0000 (Business), or 0-000-000-0000 (Individual – Self-Employed/Business Owners), or 0-000-000-0000 (Individuals – Wage Earners) Or write Submit a new Form W-4 to your employer to increase your withholding. (City, State, and ZIP Code) Employer (Name, address, and telephone number) Financial Institution (Name and address) Kinds of taxes (Form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Originator CodeA 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. Kinds of taxes (form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Name: Title: Code FILED ON ANY PORTION OF YOUR LIABILITY WHICH Name Title REPRESENTS AN INDIVIDUAL SHARED RESPONSIBILITY 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. 7-2018) Part 2 — Taxpayer’s Copy 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 receive a notice from us prior to termination of your agreement. • 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 aa scheduled payment, contact us immediately. • This agreement is based on your current financial condition. We may modify or terminate the agreement if our information shows that your ability to pay has significantly changed. You must provide updated financial information when requested. • While this agreement is in effect, you must file all federal tax returns and pay any (federal) taxes you owe on time. • We will apply your federal tax refunds or overpayments (if any) to the entire amount you owe, including the shared responsibility payment under the Affordable Care Act, until it is fully paid or the statutory period for collection has expired. • You must pay a $225 user fee, which we have authority to deduct from your first payment(s) ($107 for Direct Debit). For low-income taxpayers (at or below 250% of Federal poverty guidelines), the user fee is reduced to $43. The reduced user fee will be waived if you agree to make electronic payments through a debit instrument by providing your banking information in the Direct Debit section of this Form. For low-income taxpayers, unable to make electronic payments through a debit instrument, the reduced user fee will be reimbursed upon completion of the installment agreement. See Debit Payment Self- Identifier on page 1 and Form 13844 for qualifications and instructions. • If you default on your installment agreement, you must pay a $89 reinstatement fee if we reinstate the agreement. We have the authority to deduct this fee from your first payment(s) after the agreement is reinstated. • We will apply all payments on this agreement in the best interests of the United States. Generally we will apply the payment to the oldest collection statute, which is normally the oldest tax year or period. • We can terminate your installment agreement if: • You do not make monthly installment payments as agreed. You do not pay any other federal tax debt when due. You do not provide financial information when requested. • If we terminate your agreement, we may collect the entire amount you owe, EXCEPT the Individual Shared Responsibility Payment under the Affordable Care Act, by levy on your income, bank accounts or other assets, or by seizing your property. • 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 when we approve or don’t approve the agreement. • We may file a Notice of Federal Tax Lien if one has not been filed previously which, may negatively impact your credit rating, but we will not file a Notice of Federal Tax Lien with respect to the individual shared responsibility payment under the Affordable Care Act.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Originator CodeA 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. Kinds of taxes (Form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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: Originator 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. 1-2017) Part 1 — IRS Copy Form 433-D (January 2017) Department of the Treasury - Internal Revenue Service Installment Agreement (See Instructions on the back of this page) Name and address of taxpayer(s) Social Security or Employer Identification Number (SSN/EIN) (Taxpayer) (Spouse) Your telephone numbers (including area code) (Home) (Work, cell or business) For assistance, call: 0-000-000-0000 (Business), or 0-000-000-0000 (Individual – Self-Employed/Business Owners), or 0-000-000-0000 (Individuals – Wage Earners) Or write Submit a new Form W-4 to your employer to increase your withholding. (City, State, and ZIP Code) Employer (name, address, and telephone number) Financial Institution (name and address) Kinds of taxes (form numbers) Tax periods Amount owed as of $ I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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 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. 8-2022) Part 1 — IRS Copy I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form for: • Your name (include spouse’s name if a joint return) page. Please review them thoroughly. By initialing here and current address; • Your social security number and/or employer identification number (whichever applies my signature below, I agree 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 , as provided in this agreement form, please sign and date itif it is approved by the Internal Revenue Service. 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. Additional Conditions / Terms of this agreement (To be completed by IRS) By completing signing and submitting this agreementform, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process and administer this agreement over its duration. DIRECT DEBIT — Attach a voided check or complete this part only if you (choose to make payments by direct debit. Read 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 instructions on the front back of this form. If you cannot make apage.

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 employeeEmployer (Name, please fill in address, and telephone number) Financial Institution (Name and address) Kinds of taxes (Form numbers) Tax periods Amount owed as of $ I / We agree to pay the information in federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows: $ on and $ on the spaces of each month thereafter I / We also agree to increase or decrease the above installment payment as follows: Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT—Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.

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: Cycle Earliest CSED: MAY BE FILED IF THIS AGREEMENT DEFAULTS 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 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. 7-2018) Part 1 — IRS Copy I / We agree to pay the federal taxes shown above, PLUS PENALTIES AND INTEREST PROVIDED BY LAW, as follows $ on and $ on the of each month thereafter I / We also agree to increase or decrease the above installment payments as follows: Originator Code: Name: Title: INSTRUCTIONS TO TAXPAYER If not already completed by an IRS employee, please fill in the information in the spaces Date of increase (or decrease) Amount of increase (or decrease) New installment payment amount The terms of this agreement are provided on the front back of this form forpage. Please review them thoroughly. Please initial this box after you’ve reviewed all terms and any additional conditions. Additional Conditions / Terms (To be completed by IRS) Note: • Your name (include spouse’s name if a joint return) Internal Revenue Service employees may contact third parties in order to process 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 maintain this agreement. When you’ve completed DIRECT DEBIT — Attach a voided check or complete this agreement form, please sign and date itpart only if you choose to make payments by direct debit. Then, return Part 1 to IRS at Read the address instructions on the letter that came with it or the address shown in the “For assistance” box on the front of the form. Terms back 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 apage.