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Get Ks Ce-5 2019-2024

Kansas Department of Revenue Compliance and Enforcement PO Box 12005 Topeka KS 66601-3005 Petition for Abatement Collectability Part 1 Personal Information Name of Petitioner Spouse Address Home Phone City State Zip Social Security Number Spouse Social Security Number FEIN Business Phone Type of tax es Tax Periods Part 2 Liability Reduction Payment offer Proposed date of payment You MUST include an offer and date of intended payment NOTE Any payment received will be applied to your account and does not constitute acceptance of this petition. Please detail the reason why all or part of the liability should be reduced. If the reason is based on insolvency or inability to pay a completed Financial Information Statement must also be included. CE-5 Rev. 12/16 Part 3 Complete for Business Accounts ONLY If taxes for which settlement is being sought include business tax types is the business Active Inactive If the debt includes withholding retailer s sales retail liquor drink tax or other trust tax principal what did petitioner do with the trust taxes collected Part 4 Application Fee Payment and Source of Funds Please tell us where you will obtain the funds to pay your offer. Joint debtor s signature Taxpayer signature Dated this day of 20 Subscribed and sworn to before me this day of. You may consider borrowing from friends and/or family taking out a loan or selling assets. Part 5 Sign and Notarize accurate and true and sign this petition under penalty of perjury.

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