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                                                                                                                                                                                                                                PRINT      CLEAR

                 Worksheet for Offer in Compromise - Self-Employed Individuals                                                                                             Web-fill Form OIC-101C
                 Must complete RO-1062 prior to completion of Worksheet

                 Step 1: Assessing Liquid Assets - Section 3

                 Cash on Hand - Line 12 + Line 59
                 Average Bank Balance - Section 3 Line 13e + Section 11 Line 60c
                 Investment account balance (stocks, bonds, retirement, virtual currency) - Line 14e + Line 15d
                 Cash value of insurance policy - Line 16c
Total Liquid Assets
                                                                                                                                                                                                                                          A
                 Step 2: Real Property - Section 4

                 Fair Market Value                                                                                                x 80% - Loan Balance                   = Asset Value                                                    B
                                                                                                               Section 4 Line 17c   QSV                Section 4 Line 17d

                 Step 3: Purchased Vehicle/Other Licensed Asset - Section 5 and Business Assets Section 9

                 Fair Market Value                                                                                                x 80% - Loan Balance                   = Asset Value                                                    C
                                                                                                               Section 5 Line 18c   QSV                Section 5 Line 18d

                 Step 4: Subtracting Judgements/Liens - Section 7
                                                                                                                                                                           Balance due                                                    D
                                                                                                                                                                                                                     Section 7 Line 20d
                 Step 5: Total Equity in Assets Held 
                                                                                                                                                                                                                                          E
                                                                                                                                                                                                                     (A+B+C)-D = E
                 Step 6: Disposable Income Analysis - Section 10 / 12

Total Monthly Income (Line 36 + Line 72)                                                                                                                                                                                                  F
                                                                                                                                                                                                                     Section 10 Line 36  +
                 Less                                                                                                                                                                                                Section 12 Line 72
                                  Total Monthly Expenses (Line 48 + Line 84)
                                  Housing and Utilities, Vehicle ownership & operating costs, food & clothing, health & life insurance, out-of-pocket 
                                  medical, alimony, child support, and other court-ordered payments, child care, tax payments                                                                                                             G
                                                                                                                                                                                                                     Section 10 Line 48 +
                                                                                                                                                                                                                     Section 12 Line 84

                                  Disposable Monthly Income:                                                                                                                                                                              H
                                                                                                                                                                                                                     F-G = H
                 Step 7: Proposed Offer Amount 
                 not enter amounts**  Do       $0.00. below If in assets  equity disposable calculationsincome                      or
                                               are less than $0.00, enter $0.00.

                                  Equity in Assets Held (E)                                                                                                                                                                               I

                                  Disposable Monthly Income (H)                                        x                                   60 (months)                                                             =                      J
                                                                                                                                                                                                                     H x 60

Reasonable Collection Potential                                                                                                                                                                                                           K
                                                                                                                                                                                                                     I + J = K
Allowance for Accounting/Legal Fees (not to exceed $2,000-must provide receipt)                                                                                                                                                           L
Proposed Amount Offered in Compromise (must be greater than 0)                                                                                                                                                                            M
                                                                                                                                                                                                                     K-L = M

20% Deposit (see instruction for exceptions)                                                                                                                                                                                              N
                                                                                                                                                                                                                     M x 20% = 0