Form (June 2010) 14135 Department of the Treasury -- Internal Revenue Service Application for Certificate of Discharge of Property from Federal Tax Lien OMB No. 1545-2174 Complete the entire application. Enter NA (not applicable), when appropriate. Attachments and exhibits should be included as necessary. Additional information may be requested of you or a third party to clarify the details of the transaction(s). 1. Taxpayer Information (Individual or Business named on the notice of lien): Name (Individual First, Middle Initial, Last) or (Business) as it appears on lien Name Continuation (Individual First, Middle Initial, Last) or (Business d/b/a) Address (Number, Street, P.O. Box) City Telephone Number (with area code) State Fax Number (with area code) Primary Social Security Number (last 4 digits only) Secondary Social Security Number (last 4 digits only) Employer Identification Number ZIP Code 2. Applicant Information: Name (First, Middle Initial, Last) Address (Number, Street, P.O. Box) City Telephone Number (with area code) Check if also the Taxpayer (If not the taxpayer, attach copy of lien. See Sec.10) Relationship to taxpayer State Fax Number (with area code) ZIP Code 3. Purchase/Transferee/New Owner Check if also the Applicant Relationship to taxpayer Attached: Form 8821 or Power of Attorney Form 2848 4. Attorney/Representative Information Name (First, Middle Initial, Last) Address (Number, Street, P.O. Box) City Telephone Number (with area code) State Yes No Interest Represented (e.g. taxpayer, lender, etc.) ZIP Code Fax Number (with area code) 5. Lender/Finance Company Information - or (Settlement/Escrow Company for applications under Section 6325(b)(3) only) Company Name Catalog Number 54727S Contact Name www.irs.gov Contact Phone Number Form 14135 (Rev. 06-2010) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 6. Monetary Information Proposed sales price Expected proceeds to be paid to the United States in exchange for the certificate of discharge (Enter NA if no proceeds are anticipated) 7. Basis for Discharge: Check the box below that best addresses what you would like the United States to consider in your application for discharge. (Publication 783 has additional descriptions of the Internal Revenue Code sections listed below.) 6325(b)(1) Value of property remaining attached by the lien(s) is at least double the liability of the federal tax lien(s) plus other encumbrances senior to the lien(s) (Note: If you are applying under 6325(b)(2)(A) and are the property owner but not the taxpayer, see also section 16.) 6325(b)(2)(A) The United States receives an amount not less than the value of the United States' interest. 6325(b)(2)(B) Interest of the United States in the property to be discharged has no value. 6325(b)(3) 6325(b)(4) Proceeds from property sale held in escrow subject to the liens and claims of the United States. Deposit made or bond furnished in an amount equal to the value of the United States' interest. (Note: This selection provides a remedy under 7426(a)(4) for return of deposit but is exclusively for a property owner not named as the taxpayer on the lien) 8. Description of property (for example, 3 bedroom rental house; 2002 Cessna twin engine airplane, serial number AT919000000000X00; etc.): Address of real property (If this is personal property, list the address where the property is located): Address (Number, Street, P.O. Box) City State ZIP Code FOR REAL ESTATE: a legible copy of the deed or title showing the legal description is required FOR Discharge Requests under Section 6325(b)(1): copy of deed(s) or title(s) for property remaining subject to the Federal Tax Lien is required 9. Appraisal and Valuations REQUIRED APPRAISAL Professional appraisal completed by a disinterested third party PLUS ONE OF THE FOLLOWING ADDITIONAL VALUATIONS: County valuation of property (real property) Informal valuation of property by disinterested third party Proposed selling price (for property being sold at auction) Other: Attached Attached NA NA Attached Attached Attached Attached Attached AND for applications under Section 6325(b)(1), valuation information (of the type described above in this section) must also be provided for property remaining subject to the lien. Catalog Number 54727S www.irs.gov American LegalNet, Inc. www.FormsWorkFlow.com Form 14135 (Rev. 06-2010) Page 3 of 3 10. Copy of Federal Tax Lien(s) (Complete if applicant and taxpayer differ) OR list the lien number(s) found near the top right corner on the lien document(s) (if known) Attached No 11. Copy of the sales contract/purchase agreement (if available) OR Describe how and when the taxpayer will be divested of his/her interest in the property: Attached No 12. Copy of a current title report OR Attached No List encumbrances senior to the Federal Tax Lien. Include name and address of holder; description of encumbrance, e.g., mortgage, state lien, etc.; date of agreement; original loan amount and interest rate; amount due at time of application; and family relationship, if applicable (Attach additional sheets as needed): 13. Copy of proposed closing statement (aka HUD-1) OR Attached No Itemize all proposed costs, commissions, and expenses of any transfer or sale associated with property (Attach additional sheets as needed): 14. Additional information that may have a bearing on this request, such as pending litigation, explanations of unusual situations, etc., is attached for consideration 15. Escrow Agreement (For applications under IRC 6325(b)(3)) Escrow agreement must specify type of account, name and depositary for account, conditions under which payment will be made, cost of escrow, name and address of any party identified as part of escrow agreement, and signatures of all parties involved including Advisory Group Manager. Terms for agreement must be reached before discharge approved. Attached Attached No No 16. WAIVER (For applications made by third parties under IRC 6325(b)(2)) If you are applying as an owner of the property and you are not the taxpayer, to have this application considered under section 6325(b)(2), you must waive the rights that would be available if the application were made under section 6325(b)(4). If you choose not to waive these rights, the application will be treated as one made under 6325(b)(4) and any payment will be treated like a deposit under that section. Please check the appropriate box. I understand that an application and payment made under sectio