Petition for Remission Form - Page 1

Identity of Claim Filer

Are you an attorney filing this Petition on behalf of your client?* What are the requirements for filing on behalf of the Petitioner?

  •   No, I am the Petitioner filling out this Petition.
  •   Yes, I am an attorney filling out this Petition on behalf of the Petitioner.

Note: Depending on your answer, you may skip pages of this form.

Petitioner Identification

Please select which type of Petitioner you are:*

:*
:*
:
:*

Co-Petitioner's Name (If applicable, provide all information)

:
:
:

Petitioner's Social Security Number:*

Note: If you do not have a Social Security number, enter "999999999".

:*
:*

Taxpayer Identification Number:*

:*
:*
:*
:
:
:
:
:*
:*
:*
:*
:*
:
:*
 Page 1 of 6