HOW TO PREPARE THEOFFER IN COMPROMISE FINANCIAL STATEMENT (DE 999B) 

Your request for an Offer in Compromise cannot be processed if the DE     999B is incomplete or unsigned. The DE          999B 
must be signed and dated by the applicant.Complete all blocks, except shaded areas. The DE 999B must include 
complete information for you and your spouse or your corporation. All of your spouse’s assets and income are 
applicable. If you are self‑employed or currently involved in an active business as a partner or corporate officer, 
you must enclose a current profit and loss statement with the DE 999B.You must submit copies of your personal 
federal tax returns for the last two years. If you and your spouse filed separate returns, both returns must be 
submitted. Full financial disclosure is required and supporting documents must be attached to your DE 999B. Upon 
receipt of your offer, additional information may be requested for processing. 

Note: If you are filing on behalf of a corporation, the DE 999B should be completed with the corporation’s information 
and not the individual’s information. 

CURRENT ASSETS                                                    Income — Enter gross amount of wages/salary 
Bank Account— Enter all accounts even if there is                 (attach pay stubs for the last six months). If you are 
currently no balance. DO NOT enter bank loans.                    self‑employed, enter your net business income (what 
You MUST enclose copies of bank statements for                    you earn after you have paid your ordinary, necessary 
all accounts for the last six months (if you have                 monthly business expenses) and attach a current 
seasonal sporadic employment, you must enclose                    profit/loss statement and balance sheet. List net 
copies of bank statements for all accounts for the last           rental income and identify sources of other income. 
12 months). 
Accounts/Notes Receivable — Enter requested                       Necessary Living Expenses — Enter mandatory payroll 
information. Also attach a separate list describing               deductions (regular withholding for state and federal 
when the receivable is due and how frequent (i.e.,                taxes and Social Security). Do not include insurance 
regular customer or one‑time customer).                           payments, loan payments, or wage garnishments, 
Available Credit Sources — List only credit lines or              etc. Attach an itemized list for medical, insurance, 
cards by a bank, credit union, or savings and loan                vehicle, and other expenses. Submit documentation 
institution that have cash advance features. Attach all           that court‑ordered payments and child/spousal 
revolving credit card statements.                                 support payments have been paid for the last 
                                                                  six months and are currently being paid. Submit 
PERSONAL ASSETS                                                   documentation of all wage garnishments, payment 
Enter all vehicles, boats, RVs, motorcycles,  campers,            plans, estimated tax payments, and settlement offers 
etc. Attach a list detailing where the assets are                 with the Internal Revenue Service, other tax agencies, 
located, the registered owners and lien holders, and              and general creditors. Submit lien information on 
expected payoff dates.                                            these liabilities. This information may be obtained 
                                                                  from a credit report or through the County Recorder 
REAL PROPERTY ASSETS                                              Office in which the property is located. 
List all real estate that you own or are purchasing, 
both as an individual or with others. Attach a list               EMPLOYMENT INFORMATION 
of all owners’ names and type of ownership (joint                 Include the business name and address. 
tenants, tenants in common), describe type of 
buildings on the property, mortgage payments,                     OTHER INFORMATION 
rental income amounts, and what the property is                   Mark the appropriate box. For all “yes” answers, enter 
used for (residence, office/shop, rental). Submit lien            full explanation in space provided. 
information on all properties and current mortgage 
                                                                  HEALTH/MEDICAL CONSIDERATIONS 
statement(s). 
                                                                  Describe in the space provided any health, disability, 
MONTHLY INCOME AND EXPENSES                                       or medical considerations that do or will effect 
List total household income and expenses for both                 current or future financial status or earning potential 
you and your spouse, even if only one spouse has a                for either you or your spouse. Submit supporting 
tax liability.                                                    documentation. 

                      For further information or assistance, please contact the Offer in Compromise Unit at 1-916-464-2739
 The EDD is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities

DE 999C Rev. 2 (2‑19) (INTERNET)                        Page 1 of 1                                                       CU