Notice of Proposed Adjustment

Department of the Treasury - Internal Revenue Service

Entity for this proposed adjustment

Based on the information we now have available and our discussions with you, we believe the proposed adjustment listed below should be

included in the revenue agent's report. However, if you have additional information that would alter or reverse this proposal, please

furnish this information as soon as possible.

Reasons for Proposed Adjustment (If the explanation of the adjustment will be longer than the space provided below, the entire explanation should begin on Form 886-A (Explanation of Items.).

Taxpayer's / Representative's Action:

Have additional information; will submit by:

Agreed in Part

Agreed Disagreed

Date

Team Manager

Cat. No. 42770J www.irs.gov Form 5701 (Rev. 12-2006)

Form 5701

(Rev. December 2006)

Part 1 - Taxpayer's File Copy

If Disagreed in Part or in Full - Check here for consideration of Fast Track Settlement

Taxpayer

IRS

Date

Taxpayer's / Representative's Signature

Name of taxpayer Issue No.

Name and title of person to whom delivered

Date

Years Amount Account or return line SAIN NO. Issue Code

Department of the Treasury - Internal Revenue Service

Notice of Proposed Adjustment

Entity for this proposed adjustment

Based on the information we now have available and our discussions with you, we believe the proposed adjustment listed below should be

included in the revenue agent's report. However, if you have additional information that would alter or reverse this proposal, please

furnish this information as soon as possible.

Reasons for Proposed Adjustment (If the explanation of the adjustment will be longer than the space provided below, the entire explanation should begin on Form 886-A (Explanation of Items.).

Taxpayer's / Representative's Action:

Have additional information; will submit by:

Agreed in Part

Agreed Disagreed

Date

Team Manager

Cat. No. 42770J www.irs.gov Form 5701 (Rev. 12-2006)

Form 5701

(Rev. December 2006)

Part 2 - To Be Returned By Taxpayer With Reply

If Disagreed in Part or in Full - Check here for consideration of Fast Track Settlement

Taxpayer

IRS

Date

Taxpayer's / Representative's Signature

Name of taxpayer Issue No.

Name and title of person to whom delivered

Date

Years Amount Account or return line SAIN NO. Issue Code

Department of the Treasury - Internal Revenue Service

Notice of Proposed Adjustment

Entity for this proposed adjustment

Based on the information we now have available and our discussions with you, we believe the proposed adjustment listed below should be

included in the revenue agent's report. However, if you have additional information that would alter or reverse this proposal, please

furnish this information as soon as possible.

Reasons for Proposed Adjustment (If the explanation of the adjustment will be longer than the space provided below, the entire explanation should begin on Form 886-A (Explanation of Items.).

Taxpayer's / Representative's Action:

Have additional information; will submit by:

Agreed in Part

Agreed Disagreed

Date

Team Manager

Cat. No. 42770J www.irs.gov Form 5701 (Rev. 12-2006)

Form 5701

(Rev. December 2006)

Part 3 - Requester's File Copy

If Disagreed in Part or in Full - Check here for consideration of Fast Track Settlement

Taxpayer

IRS

Date

Taxpayer's / Representative's Signature

Name of taxpayer Issue No.

Name and title of person to whom delivered

Date

Years Amount Account or return line SAIN NO. Issue Code

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