Form 12277 

(October 2011) 

Department of the Treasury — Internal Revenue Service 

Application for Withdrawal of Filed 

Form 668(Y), Notice of Federal Tax Lien

(Internal Revenue Code Section 6323(j)) 

1. Taxpayer Name (as shown on the Notice of Federal Tax Lien) 2. Social Security/Employer Identification No. 

3. Taxpayer's Representative, if applicable, or Name and Title of contact person, if taxpayer is a business 

4. Address (Number, Street, P.O. Box) 

5. City 6. State 7. ZIP code 8. Phone Number 

9. Attach copy of the Form 668(Y), Notice of Federal Tax Lien, if available, OR, if you don't have a copy, provide the 

following information, if available: 

Serial number of Form 668(Y) (found near the top of the document) Date Form 668(Y) filed 

Recording office where Form 668(Y) was filed 

10. Current status of the federal tax lien ("x" appropriate box) 

Open Released Unknown 

11. Reason for requesting withdrawal of the filed Notice of Federal Tax Lien ("x" appropriate box(es)) 

The Notice of Federal Tax Lien was filed prematurely or not in accordance with IRS procedures. 

The taxpayer entered into an installment agreement to satisfy the liability for which the lien was imposed

and the agreement did not provide for a Notice of Federal Tax Lien to be filed. 

The taxpayer is under a Direct Debit Installment Agreement. 

Withdrawal will facilitate collection of the tax. 

The taxpayer, or the Taxpayer Advocate acting on behalf of the taxpayer, believes withdrawal is in the

best interest of the taxpayer and the government. 

12. Explain the basis for the withdrawal request (attach additional sheets and other documentation that substantiates your 

request, as needed) 

Affirmation 

Under 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 (Taxpayer or Representative) Title (if business) Date 

Catalog Number 27939C www.irs.gov Form 12277 (Rev. 10-2011) 
	 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 

	 

	 

	 

	 

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General Instructions 

1.	 Complete the application. If the information you supply is 

not complete, it may be necessary for the IRS to obtain 

additional information before making a determination on the 

application. 

Sections 1 and 2: Enter the taxpayer's name and
 

Social Security Number (SSN) or Employer
 

Identification Number (EIN) as shown on the Notice of
 

Federal Tax Lien (NFTL).
 

Section 3: Enter the name of the person completing
 

the application if it differs from the taxpayer's name in
 

section 1 (for example, taxpayer representative). For
 

business taxpayers, enter the name and title of person
 

making the application. Otherwise, leave blank.
 

Sections 4 through 8: Enter current contact information
 

of taxpayer or representative.
 

Section 9: Attach a copy of the NFTL to be withdrawn,
 

if available. If you don't have a copy of the NFTL but
 

have other information about the NFTL, enter that
 

information to assist the IRS in processing your
 

request.
 

Section 10: Check the box that indicates the current
 

status of the lien.
 

"Open" means there is still a balance owed with
 

respect to the tax liabilities listed on the NFTL.
 

"Released" means the lien has been satisfied or is no
 

longer enforceable.
 

"Unknown" means you do not know the current status
 

of the lien.
 

Section 11: Check the box(es) that best describe the
 

reason(s) for the withdrawal request. NOTE: If you are
 

requesting a withdrawal of a released NFTL, you
 

generally should check the last box regarding the best
 

interest provision.
 

Section 12: Provide a detailed explanation of the
 

events or the situation to support your reason(s) for the
 

withdrawal request. Attach additional sheets and
 

supporting documentation, as needed.
 

Affirmation: Sign and date the application. If you are
 

completing the application for a business taxpayer,
 

enter your title in the business.
 

2.	 Mail your application to the IRS office assigned your 

account. If the account is not assigned or you are 

uncertain where it is assigned, mail your application to IRS, 

ATTN: Advisory Group Manager, in the area where you live 

or is the taxpayer's principal place of business. Use 

Publication 4235, Advisory Group Addresses, to determine 

the appropriate office. 

3.	 Your application will be reviewed and, if needed, you may 

be asked to provide additional information. You will be 

contacted regarding a determination on your application. 

a. If a determination is made to withdraw the NFTL, we

 will file a Form 10916(c), Withdrawal of Filed Notice of

 Federal Tax Lien, in the recording office where the

 original NFTL was filed and provide you a copy of the

 document for your records.

 b. If the determination is made to not withdraw the

 NFTL, we will notify you and provide information

 regarding your rights to appeal the decision. 

4.	 At your request, we will notify other interested parties 

of the withdrawal notice. Your request must be in 

writing and provide the names and addresses of the 

credit reporting agencies, financial institutions, and/or 

creditors that you want notified. 

NOTE: Your request serves as our authority to release the 

notice of withdrawal information to the agencies, financial 

institutions, or creditors you have identified. 

5.	 If, at a later date, additional copies of the withdrawal notice 

are needed, you must provide a written request to the 

Advisory Group Manager. The request must provide:

 a. The taxpayer's name, current address, and taxpayer

 identification number with a brief statement

 authorizing the additional notifications;.

 b. A copy of the notice of withdrawal, if available; and

 c. A supplemental list of the names and addresses of

 any credit reporting agencies, financial institutions, or

 creditors to notify of the withdrawal of the filed Form

 668(Y). 

.	 Privacy Act Notice 

We ask for the information on this form to carry out the 

Internal Revenue laws of the United States. The primary 

purpose of this form is to apply for withdrawal of a notice of 

federal tax lien. The information requested on this form is 

needed to process your application and to determine 

whether the notice of federal tax lien can be withdrawn. 

You are not required to apply for a withdrawal; however, if 

you want the notice of federal tax lien to be withdrawn, you 

are required to provide the information requested on this 

form. Sections 6001, 6011, and 6323 of the Internal 

Revenue Code authorize us to collect this information. 

Section 6109 requires you to provide the requested 

identification numbers. Failure to provide this information 

may delay or prevent processing your application; providing 

false or fraudulent information may subject you to penalties.

 Routine uses of this information include giving it to the 

Department of Justice for civil and criminal litigation, and to 

cities, states, the District of Columbia, and U.S. 

commonwealths and possessions for use in administering 

their tax laws. We may also disclose this information to 

other countries under a tax treaty, to federal and state 

agencies to enforce federal nontax criminal laws, or to 

federal law enforcement and intelligence agencies to 

combat terrorism. 

Catalog Number 27939C	 www.irs.gov Form 12277 (Rev. 10-2011)