Installment Agreement Request Farm 9465 (Rev. December 2013) Department of the Treasury Internal Revenue Senna/ ► Information about Form 9465 and its separate instructions is at wwwits.govilom79465. ► If you are filing this form with your tax return, attach it to the front of the return. ► See separate instructions. OMB No. 154S-0074 Tip: If you owe $50,000 or less, you may be able to establish an installment agreement online, even if you have not yet received a bill for your taxes. Go to IRS.gov to apply to pay online. Caution: Do not file this form if you are currently making payments on an installment agreement or can pay your balance in full within 120 days. Instead, call 1-800-829-1040. Do not file if your business is still operating and owes employment or unemployment taxes. Instead, call the telephone number on your most recent notice. If you are in bankruptcy or we have accepted your offer-in-compromise, see Bankruptcy or offer-in-compromise, in the instructions. Part I This request is for Forrn(s) (kr example. Form 1040 or Form 941)► and for tax year(s) (fix xample, 2012 and 2013)► ia Your first name and elitial Last name If a joint return. spouse's first name and initial Last name Your social security number Spouse's social security number Current address (number and street). If you have a box and no home &silvery. enter your box number. Apt. number City. town a post office. state. and ZIP code. If a foreign address. also complete the spaces below (see nstructions) Foreign country name Foreign province/state/coulty Foreign postal code 1b If this address is new since you filed your last tax return, check here 2 Name of your business (must be no longer operating) D Employer identification number (Elhg 3 Your home phone number Best time for us to call 4 Your work phone number Best time for us to call 5 Name of your bark or other financial institution: Address City, state, and ZIP code Your employers name: Address