- 4 -
|
The following documentation must be submitted with your OIC application or your application may be returned as
incomplete. Please submit copies only. We will notreturn any documents that you send us. Additional documentation
may be required and requested as the evaluation of the OIC proceeds.
Check List of Required Items (Check only those boxes that apply.)
Verification of Income
□
Provide pay stubs for the past three months or financial statements for the past two years if you are
self-employed.
Verification of Expenses
□
Provide billing statements for the last three months (include copies of charge card statements, bills from other
creditors, and personal loan statements ) .
Bank Information
□
Provide bank statements for savings and checking accounts (for the last six months).
If you are self-employed, provide bank statements for the last 12 months.
If any accounts have been closed within the last two years, include bank statements for the last six months of
each account before the account was closed.
□ Investment Information
Submit investment account statements showing the value of stocks, bonds, mutual funds, and/or retirement or
profit sharing plans (IRA, 401[k], Keogh, Annuity).
Current Lease or Rental Agreements
□
Include all lease agreements, including property where you are the lessor or lessee.
□ Real Property Information
Submit mortgage statements and escrow statements for property you currently own, or property you sold or
gifted in the last five years.
□ IRS/FTB Information
Submit complete copies of Internal Revenue Service (IRS) or FTB returns for the past three years.
OIC Information
□
Submit copies of offers made to other government agencies and acceptance letters or other arrangements
made to resolve your debt.
□ Legal Documents
Submit marital settlement agreements, divorce decrees, marital property settlements, trust documents, and
bankruptcy documents.
Medical Documentation
□
Submit physician’s letter including diagnosis and prognosis and/or other documents to show any medical
condition that should be considered.
Power of Attorney
□
If a designated representative submits this offer, attach the appropriate Power of Attorney (POA) Declaration,
DE 48, CDTFA-392, or FTB 3520 PIT.
Submit your completed and signed application to CDTFA, FTB, or the EDD at the corresponding address below. The OIC
application must be sent to each separate agency for processing. You should receive an acknowledgement letter from the
receiving agency within 30 working days from the date your OIC application was received. Please contact us via phone
or website.
CALIFORNIA DEPARTMENT OF FRANCHISE TAX BOARD EMPLOYMENT DEVELOPMENT DEPARTMENT
TAX AND FEE ADMINISTRATION OFFER IN COMPROMISE PO BOX 826880, MIC 92S
OFFER IN COMPROMISE PO BOX 2966, MS A453 SACRAMENTO, CA 94280-0001
PO BOX 942879, MIC 52 RANCHO CORDOVA, CA 95741-2966
SACRAMENTO, CA 94279-0052
Phone: 1-800-400-7115 Phone: 1-916-845-4787 Phone: 1-916-464-2739
Website:www.cdtfa.ca.gov Website:www.ftb.ca.gov/oic Website:www.edd.ca.gov
DE 999CA Rev. 3 (6-18) (INTERNET) Page 4 of 13
|