HOW TO PREPARE THE              OFFER 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