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Irs 14764 PDF Form: What You Should Know

Please Note: A form is not a complete tax information statement. Please complete the entire form, and keep a copy. IRS Form 14764 (April 2017) — Health Care Compliance Inc. Dear IRS, The Internal Revenue Service (“IRS” or “IRS”) has determined that the information and opinion (“Information”) provided on the attached form is correct and reliable. Accordingly, the attached Information is the final opinion of the IRS that: (1) the information in this attached form regarding your employment relationship with the taxpayer and the employment relationship of the taxpayer's spouse has the correct status as an “Employment-Related Statement” and should be entered in the “Employment-Related Statement” column; (2) the information provided on the attached form regarding (A) the date of birth of the taxpayer; (B) the taxpayer's address of residence; and (C) the employer of the taxpayer's spouse has the correct status as “Employment-Related Entity” as reflected on Form 2555, Employer's Tax Return. To the extent the information provided in the attached form contains a false or fraudulent statement, the attached form is fraudulent. Therefore, you should: (A) return all copies of the attached form to the sender in accordance with the instructions of the Information; and (B) correct the incorrect information on Form 2555, Employer's Tax Return, in reliance on the information contained in Form 14703, Fraudulent Tax Return, and the guidance provided in Internal Revenue Bulletin 2014-50. Please note that the information provided on the attached form is subject to review and revision by internal tax authorities and cannot be relied on as factual or reliable. Consequently, you should note, for example, that the date of birth for individuals born in the calendar year (January 1, January 2, and so on, inclusive) and the employer of any taxpayer whose date of birth is not known, but who has been listed on the applicable Federal Tax Roll as a “resident alien” as of April 30, 2009, the calendar year (January 1, January 2, and so on, inclusive), is unknown, and is likely an old date of birth.

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