Form 14498 Department of the Treasury­Internal Revenue Service (April 2015) Application for Consent to Sale of Property Free of the Federal Tax Lien OMB Number 1545-0854 Section 1. Applicant's Information Name (First, Middle Initial, Last) Firm name (if applicable) Telephone number (with area code) Address (Number, Street, P.O. Box) City Fax number (with area code) State ZIP Code Section 1 Optional (Additional contact names and addresses) Check here to add additional contact names and addresses Section 2. Copy of the Notice of Federal Tax Lien(s) Attached (go to Section 3) Place lien notice was prepared and signed Not attached (if box checked, complete remaining section 2 items) Earliest lien notice filing date (MM/DD/YYYY) Location lien notice filed Taxpayer's Information (Individual or Business named on the Notice of Federal Tax Lien) Name (Individual First, Middle Initial, Last) or (Business) as it appears on the notice of lien Secondary name or business (d/b/a) Address (Number, Street, P.O. Box) City State ZIP Code Section 2 Optional (Taxpayer [i.e., Foreclosed Party or Debtor] Identification and Lien Notice Identification Numbers) Check here to add Section 3. Property Real property Personal property Perishable personal property Likely to perish or be greatly reduced in price or value by keeping Provide reason property perishable if box checked Abstract of Title attached Yes No Copy of deed attached Yes No Real property legal description/Personal property detailed description Catalog Number 62858U www.irs.gov American LegalNet, Inc. www.FormsWorkFlow.com Form 14498 (4-2015) Page 2 Address (if this is personal property, list the address where the property is located) City State ZIP Code Section 3 Optional (Additional real property description) Check here to add optional information Section 4. Sale Information Sale location Terms of the sale Sale date Sale time Time zone OR Date the taxpayer's interest in the property is terminated Section 5. Principal Obligation Amount of principal obligation Interest owed to the seller Known expense amounts Total Complete description of any expenses. This may include legal expenses, selling costs, maintenance fees and expenses, which will be charged against the sale proceeds. Note: Not all expenses may be reimbursable if there is an IRS redemption of the property. Section 5 Optional (Additional property value and creditor details) Check here to add optional information IRS Completes Acknowledgement sent Acknowledge Notice of Sale Submitter Completes Acknowledgement requested Section 6. Basis for Consent Provide the reason an adequate and timely Notice of Sale cannot be provided Section 7. Adequate Protection What is being offered for the Consent IRS lien interest is valueless Reason Yes No Catalog Number 62858U www.irs.gov American LegalNet, Inc. www.FormsWorkFlow.com Form 14498 (4-2015) Page 3 Section 8. Documents Attached Substantiating documentation is attached List documents provided or reason not provided Yes No N/A Section 9. Declaration Under the penalties of perjury, I declare that I have examined this application, including any accompanying schedules, exhibits, affidavits, and statements, and to the best of my knowledge and belief it is true, correct, and complete. Signature Date Printed Name Title Catalog Number 62858U www.irs.gov American LegalNet, Inc. www.FormsWorkFlow.com Form 14498 (4-2015)