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Offer in Compromise Booklet for Individuals
Enlarge image | Offer in Compromise Booklet for Individuals |
 Enlarge image | Table of Contents What You Need to Know Before You Prepare an Offer in Compromise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Offer in Compromise Application – Checklist of Required Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Section 1 – Personal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Section 2 – Employment, Business Income, and Education Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Section 3 – General Financial Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Section 4 – Asset and Liability Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Section 5 – Monthly Household Income and Expense Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Section 6 – Three Year Income Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Section 7 – Basis for the Offer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Section 8 – Offer in Compromise Payment Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Section 9 – Statement of Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Frequent Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Franchise Tax Board Privacy Notice on Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 |
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What You Need to Know Before You Prepare an Offer in Compromise
An Offer in Compromise (OIC) provides an alternative for individuals who are unable to pay their outstanding California
income tax liabilities, and who won’t be able to in the foreseeable future .
Are You an OIC Candidate?
If you are an individual without the income, assets, or means to pay your tax liability now or in the foreseeable future, you
may be eligible for an OIC . The OIC Program allows you to offer a lesser amount for payment of a non-disputed final tax
liability .
Generally, we approve an OIC when the amount offered represents the most we can expect to collect within a
reasonable period of time .
Each case is evaluated based on its own unique set of facts and circumstances . We give the following factors strong
consideration in the evaluation:
• Ability to pay
• Value of your assets
• Present and future income
• Present and future expenses
• The potential for changed circumstances
• The offer is in the best interest of the state
Can We Process Your Application?
We will only process your OIC application if you meet the following requirements:
• File all of the required tax returns . If you have no filing requirement, note it on the application .
• Fully complete the OIC application and provide all supporting documentation .
• Agree with the Franchise Tax Board (FTB) on the amount of tax you owe .
• Provide a signed and dated 4905 PIT Application .
Will a Collateral Agreement be Required?
Upon approval, we may require you to enter into a collateral agreement for a term of five years . Generally, a collateral
agreement will be required in cases when you have a significant potential for increased earnings . A collateral agreement
requires you to pay to FTB a percentage of future earnings that exceed an agreed upon threshold .
Is Collection Activity Suspended?
Submitting an offer does not automatically suspend collection activity . In most cases, collection action will be suspended
until the OIC evaluation is completed . However, if delaying collection activity jeopardizes our ability to collect the tax, we
may continue with collection efforts . Interest, fees, and penalties continue to accrue as prescribed by law .
When Should Offered Funds be Submitted?
Do not submit the offered funds until we request them by letter . When we do ask for the funds, submit them by
cashier’s check, money order, or WebPay . The offer must be a lump sum payment . We are unable to accept installment
payments toward the offer amount or include prior payments .
FTB 4905 PIT (REV 06-2023) PAGE 3
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FTB account number: _________________
Offer in Compromise Application
You must submit the following documentation with your Offer in Compromise Application or we will return your application
as incomplete . You must include the information for you and your spouse/registered domestic partner (RDP) . Please
submit copies only . We will not return any documents that you send us . Indicate if any of the items below are not applicable
(N/A) . Additional documentation may be required and requested as the evaluation of the OIC proceeds .
Checklist of Required Items
N/A Included
◻ ◻ Verification of Household Income
Complete pay stubs for the past three months, or financial statements for the past two years if self-
employed . Include any investment or ownership in any business entity or trust, and income derived
from these sources (dividends, K-1 income, distributions, etc .) .
◻ ◻ Verification of Expenses
Billing statements for the last three months and proof that expenses are being paid . Include copies of
revolving charge card statements, bills from other creditors (student loans, signature loans, medical
bills, etc .), and personal loan statements .
◻ ◻ Bank Accounts
• List all types of accounts, including checking, savings, mobile payment service (Venmo, PayPal,
Zelle, etc .), certificates of deposits, etc ., held during the past three years .
• Provide copies of the last six months of bank statements for every bank account and the closing
statement for any account closed in the past two years .
• Provide copies of the last six months of mobile payment service history (Venmo, Paypal, Zelle, etc .) .
• If self-employed, provide bank statements for the last twelve months . Include accounts that have
been closed during that period .
◻ ◻ Securities
Investment account statements showing the most recent value of stocks, bonds, mutual funds, virtual
currencies, and/or retirement or profit sharing plans (e .g ., IRA, 401(k), Keogh, or annuity) .
◻ ◻ Current Leases or Rental Agreements, Either as Landlord or Tenant
◻ ◻ Real Estate Information
• Mortgage statements (including current balance owed and amount of monthly payment) for each
property you own .
• Most recent property tax bill for each property you own .
• Escrow statements for each property you currently own, sold, or gifted in the last five years .
◻ ◻ Internal Revenue Service (IRS) Information
• If applicable, copy of IRS OIC application and determination letter or other IRS arrangements .
• Copies of any notices of IRS adjustments or assessments that you have not reported to FTB .
• Copies of any notices regarding an IRS audit for any tax years if the audit is still open .
◻ ◻ Legal Documents
Marital settlement agreements, divorce decrees, marital property settlements, trust documents, and
bankruptcy documents .
◻ ◻ Medical Information
A signed physician’s letter including diagnosis and prognosis and/or other documents to show any
medical condition that should be considered .
◻ ◻ Power of Attorney
Copy of FTB 3520 PIT, Individual and Fiduciary Power of Attorney Declaration, if this offer is submitted
by a designated representative .
◻ ◻ Vehicle Information
Copies of loan/lease statements for any vehicles .
FTB 4905 PIT (REV 06-2023) PAGE 4 490595012274
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FTB account number: _________________
Mail your completed and signed application to:
OFFER IN COMPROMISE PROGRAM MS A453
FRANCHISE TAX BOARD
PO BOX 2966
RANCHO CORDOVA CA 95741-2966
If you have any questions, refer to the section, What you need to know before you prepare an Offer in Compromise, in
this booklet, or contact the Offer in Compromise Program at 916 .845 .4787 . You may also fax us at 916 .845 .0479 .
Important Information
Complete all areas that are not shaded . Write “n/a” in those fields that do not apply . If you filed a tax return with a
spouse/registered domestic partner (RDP), make sure to include their social security number (SSN) or individual taxpayer
identification number (ITIN) if applicable .
Section 1 Personal Information
Taxpayer’s First Name M .I . Taxpayer’s Last Name Taxpayer’ s SSN or ITIN
Other names and aliases ever used Taxpayer’ s Date of Birth
Taxpayer’s Driver License Number State Taxpayer s’ Email Taxpayer’ s Phone Number
Spouse/RDP
Spouse’s/RDP’s First Name M .I . Spouse’s/RDP’s Last Name Spouse’s/RDP’s SSN or ITIN
Other Names and Aliases Ever Used Spouse’s/RDP’s Date of Birth
Spouse’s/RDP’s Driver License Number State Spouse’s/RDP’s Email Spouse’s/RDP’s Phone Number
Dependents (Please attach additional pages if needed)
Dependent 1 (First and Last Name) Date of Birth SSN/ITIN Relationship
Dependent 2 (First and Last Name) Date of Birth SSN/ITIN Relationship
Dependent 3 (First and Last Name) Date of Birth SSN/ITIN Relationship
Current Mailing Address
Street Address (Number and Street) or PO Box Apt ./Suite
City State ZIP Code
Physical Address
Street Address (Number and Street) Apt ./Suite
City State ZIP Code
Previous Address (If at current address less than two years)
Street Address (Number and Street) Apt ./Suite
City State ZIP Code
FTB 4905 PIT (REV 06-2023) PAGE 5 490595012275
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FTB account number: _________________
Representative Information
Attach a copy of FTB 3520 PIT, Individual or Fiduciary Power of Attorney Declaration
Primary Representative’s Name (First Name, Middle Initial, and Last Name) Title Phone Number
Street Address (Number and Street) or PO Box Fax Number
City Email Address State ZIP Code
Section 2 Employment, Business Income, and Education Information
Taxpayer’ s Information
A . Current Employer or Business
Taxpayer’s Employer or Business Name Business Phone Number
Do you have any ownership in the business? Occupation How Long Employed (Years/Months)
Yes No
◻ ◻
Street Address (Number And Street) or PO Box City State ZIP Code
Position:
◻ Wage Earner Salaried ◻ Wage Earner Hourly ◻ Partner ◻ Officer ◻ Sole Proprietor
Paid:
◻ Weekly ◻ Biweekly ◻ Monthly ◻ Semi-monthly
B . Employment History (Please attach an additional page if needed . A resume is also acceptable .)
Taxpayer’s Employer or Business Name 1 Do you have any ownership in the business? How Long Employed (Years/Months)
Yes No
◻ ◻
Occupation City State ZIP Code
Taxpayer’s Employer or Business Name 2 How Long Employed (Years/Months)
Occupation City State ZIP Code
Taxpayer’s Employer or Business Name 3 How Long Employed (Years/Months)
Occupation City State ZIP Code
C. Education (Please select the highest level of education completed and completion date .)
◻ Less than high school ◻ Associate’s degree in ________________________________
◻ High school graduate or equivalent ◻ Bachelor’s degree in ________________________________
◻ Some college, no degree ◻ Master’s degree in ________________________________
◻ Doctorate degree in ________________________________
Year highest level of education was completed ____________
FTB 4905 PIT (REV 06-2023) PAGE 6 490595012276
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FTB account number: _________________
Spouse’s/RDP’ s Information
D. Current Employer or Business
Spouse’s/RDP’s Employer or Business Name Business Phone Number
Do you have any ownership in the business? Occupation How Long Employed (Years/Months)
Yes No
◻ ◻
Street Address (Number And Street) or PO Box City State ZIP Code
Position:
◻ Wage Earner Salaried ◻ Wage Earner Hourly ◻ Partner ◻ Officer ◻ Sole Proprietor
Paid:
◻ Weekly ◻ Biweekly ◻ Monthly ◻ Semi-monthly
E. Employment History (Please attach an additional page if needed . A resume is also acceptable .)
Spouse’s/RDP’s Employer or Business Name 1 Do you have any ownership in the business? How Long Employed (Years/Months)
Yes No
◻ ◻
Occupation City State ZIP Code
Spouse’s/RDP’s Employer or Business Name 2 How Long Employed (Years/Months)
Occupation City State ZIP Code
Spouse’s/RDP’s Employer or Business Name 3 How Long Employed (Years/Months)
Occupation City State ZIP Code
F. Education (Please select the highest level of education completed and completion date .)
◻ Less than high school ◻ Associate’s degree in ________________________________
◻ High school graduate or equivalent ◻ Bachelor’s degree in ________________________________
◻ Some college, no degree ◻ Master’s degree in ________________________________
◻ Doctorate degree in ________________________________
Year highest level of education was completed ____________
FTB 4905 PIT (REV 06-2023) PAGE 7 490595012277
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FTB account number: _________________
Section 3 General Financial Information
Part A — Bank Accounts
List all types of accounts, including individual retirement accounts (IRAs) and retirement plans, checking, savings, mobile
payment services (Venmo, PayPal, Zelle, etc .) certificates of deposits, etc ., held during the past three years . Provide
copies of the last six months of bank statements for every bank account and the closing statement for any account closed
in the past two years . If self-employed, provide bank statements for the last twelve months . Include accounts that have
been closed during that period . Attach additional pages if needed .
Type of Account
Institution Name Checking/Saving Account Number Balance
$
$
$
$
$
Total . Enter this amount on Section 4, line 2, (Asset and Liability Analysis) of this application . . . . . . . . ▶ $
Part B — Automobiles, Trucks, and Other Vehicles
Provide the following information for any cars, trucks, boats, RVs, etc . that you own . Attach additional pages if needed .
Year, Make, License Lender/ Current Current Available
Model Plate Number Pink Slip Holder Market Value Payoff Equity
$ $ $
Lease Own
◻ ◻
$ $ $
Lease Own
◻ ◻
$ $ $
Lease Own
◻ ◻
$ $ $
Lease Own
◻ ◻
Total . Enter this amount on Section 4, line 3, (Asset and Liability Analysis) of this application . . . . . . . . ▶ $
Part C — Life Insurance Policies
Provide the following information for any term life insurance, whole life insurance, universal life insurance, etc .
in your name . Attach additional pages if needed .
Loan/Cash
Insurance Name Policy Number Type Policy Amount Surrender Value
$ $
$ $
$ $
Total . Enter this amount on Section 4, line 4, (Asset and Liability Analysis) of this application . . . . . . . . ▶ $
FTB 4905 PIT (REV 06-2023) PAGE 8 490595012278
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FTB account number: _________________
Part D — Securities
Provide the following information for stocks, bonds, mutual funds, money market funds, virtual currency, etc .
Attach additional pages if needed .
Location/Digital Currency Exchange Quantity or
Type Number Denomination Current Value
$
$
$
$
Total . Enter this amount on Section 4, line 5, (Asset and Liability Analysis) of this application . . . . . . . . ▶ $
Part E — Safe Deposit Boxes
Provide the following information for all deposit boxes rented or accessed by you . Attach additional pages if needed .
Current Value
Institution Name and Address List of Contents of Assets
$
$
Total . Enter this amount on Section 4, line 6, (Asset and Liability Analysis) of this application . . . . . . . . ▶ $
Part F — Real Estate (Residential, Commercial, and Undeveloped Land)
Provide the following information for all property you own . Attach additional pages if needed .
Balance Due
Property Address Purchase Price Fair Market Value on Mortgage Equity Value
$ $ $ $
$ $ $ $
$ $ $ $
Total. . . . . . . . . . . . . . . . . . . . . . . ▶ . . $. . . . . . . . . . $. . $ $
Part G — Affiliated Business and Trusts
Investment or affiliation in any business entity or trust, and income derived from these sources (dividends, K-1 income,
distributions, etc .) .
Name of Business or Trust FEIN/FTB ID Affiliation or Position
Outstanding loans from business or trust ________________________________________________________________
Loan Amount _________________________ Loan Date ________________________
How were the loans used? ___________________________________________________________________________
FTB 4905 PIT (REV 06-2023) PAGE 9 490595012279
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FTB account number: _________________
Part H — Lines of Credit and Credit Cards
Provide the following information for all your lines of credit and credit cards . Attach additional pages if needed .
Type of Name of Minimum Credit
Account Credit Grantor Monthly Payment Credit Limit Availability Amount Owed
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
$ $ $ $
Total Payments. Enter total of payments on Total Owed. Enter total owed on
Section 5, Line 32 of this application. ▶ $ Section 4, Line 22 of this application. ▶ $
Part I — Additional Financial Information
Provide the following information relating to you and your spouse’s/RDP’s financial condition . If you check yes, provide
dates, explanation, and documentation .
Court Orders (alimony, child support,
and restitution) . . . . . . . . . . . . . . . . . . . . . . . . Yes ◻ No ___________________________________________
◻
Repossessions . . . . . . . . . . . . . . . . . . . . . . . . ◻ Yes ◻ No ___________________________________________
Anticipated increase in income . . . . . . . . . . . . ◻ Yes ◻ No ___________________________________________
Bankruptcies/receiverships . . . . . . . . . . . . . . . ◻ Yes ◻ No ___________________________________________
Recent transfer of assets . . . . . . . . . . . . . . . . ◻ Yes ◻ No ___________________________________________
Beneficiary to trust, estate, profit sharing, etc . . ◻ Yes ◻ No ___________________________________________
Last California income tax return filed . . . . . . . Year _________ ___________________________________________
Total exemptions you claim from return . . . . . . _____________ ___________________________________________
Adjusted gross income from return . . . . . . . . . _____________ ___________________________________________
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FTB account number: _________________
Section 4 Asset and Liability Analysis
Assets
1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Bank accounts/balance (from Section 3, Part A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Vehicles/available equity (from Section 3, Part B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Loan/cash surrender value of life insurance (from Section 3, Part C) . . . . . . . . . . . . . . . . . . . . . 4
5 Securities (from Section 3, Part D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Safe deposit box value of contents (from Section 3, Part E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Total Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 7
Real Estate
Enter from Section 3, Part F .
8 Total Equity of Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Other Assets
9 Notes (promissory notes, Treasury notes, etc .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Judgements/settlements receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Aircraft, watercraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Interest in trusts (e .g ., trustee, trustor, beneficiary, etc ., regardless of value) . . . . . . . . . . . . . . 13
14 Interest in estates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Interest in business entities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Other assets ___________________________________________________ . . . . . . . . . . . 16
17 Other assets ___________________________________________________ . . . . . . . . . . . 17
18 Other assets ___________________________________________________ . . . . . . . . . . . 18
19 Other assets ___________________________________________________ . . . . . . . . . . . 19
20 Total Other Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ . 20
21 Sum total of assets (equity and other) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Current Liabilities
Enter your current liabilities, including judgments, notes, and other charge accounts . Do not include vehicle or home loans .
22 Total owed for lines of credit (from Section 3, Part H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
23 Taxes owed to IRS (provide a copy of recent notices) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Other liabilities ___________________________________________________ . . . . . . . . . 24
25 Other liabilities ___________________________________________________ . . . . . . . . . 25
26 Other liabilities ___________________________________________________ . . . . . . . . . 26
27 Other liabilities ___________________________________________________ . . . . . . . . . 27
28 Total Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ . 28
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FTB account number: _________________
Section 5 Monthly Household Net Income and Expense Analysis
Monthly Net (NOT Gross) Income FTB use only
1 Wages/salaries, tips, etc . (Taxpayer) . . . . . . . . . . . . . . . . . . . 1
2 Pension (Taxpayer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Overtime/bonuses/commissions (Taxpayer) . . . . . . . . . . . . . 3
4 Wages/salaries, tips, etc . (Spouse/RDP) . . . . . . . . . . . . . . . . 4
5 Pension (Spouse/RDP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Overtime/bonuses/commissions (Spouse/RDP) . . . . . . . . . . 6
7 Business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Rental income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Interest/dividends/royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Payments from trust/partnerships/entities . . . . . . . . . . . . . . . 10
11 Child support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Alimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Unemployment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Social Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Other household income ________________________ . . 16
17 Total Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 17
Expenses Amount
18 Rent/mortgage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 Real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Home insurance _________ & Association fees _________ . . 20
21 Groceries, number of people _________ . . . . . . . . . . . . . . . . 21
22 Utilities a . Cable ___________ & Internet _____________ . . 22a
b . Electric _________ & Phone ______________ . . 22b
c . Gas ____________ & Water _______________ . . 22c
d . Trash ___________ & Sewer ______________ . . 22d
23 Auto payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Auto insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
25 Gasoline, number of miles to work _______________ . . . . . . 25
26 Life/health insurance (if not deducted from paycheck) . . . . . . 26
27 Medical payments (not covered by insurance) . . . . . . . . . . . . 27
28 Estimated tax payments (if not deducted from paycheck) . . . . 28
29 Court-ordered payments (alimony, child support, restitution) . 29
30 Garnishments (if not deducted from your paycheck) . . . . . . . . 30
31 Delinquent tax (taxes not owed to FTB) . . . . . . . . . . . . . . . . . 31
32 Credit card payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
33 Other expenses . ________________________________ . . . 33
34 Other expenses . ________________________________ . . . 34
35 Total Monthly Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 35
Difference Between Total Monthly Net Income and
36 Total Monthly Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
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FTB account number: _________________
Section 6 Three-Year Income Summary
Please provide an income summary of the current year and the two preceding years .
Income Year Income Year Current Year
Gross Household Income __________ __________ __________
1 Wages/salaries, tips, etc . (Taxpayer) . . . . . . . . . . . . . . . . . . . 1
2 Pension (Taxpayer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Overtime/bonuses/commissions (Taxpayer) . . . . . . . . . . . . . . 3
4 Wages/salaries (Spouse/RDP) . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Pension (Spouse/RDP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Overtime/bonuses/commissions (Spouse/RDP) . . . . . . . . . . 6
7 Business income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Rental income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Interest/dividends/royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Payments from trust/partnerships/entities . . . . . . . . . . . . . . . 10
11 Child support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Alimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Unemployment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Social Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Ecommerce Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Other income ______________________________ . . . . 17
18 Other income ______________________________ . . . . 18
19 Other income ______________________________ . . . . 19
20 Total Gross Household Income . . . . . . . . . . . . . . . . . . . ▶ 20
Section 7 Basis for the Offer
The following facts and reasons are submitted as grounds for acceptance of this offer . Attach additional pages if needed .
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FTB account number: _________________
Section 8 Offer in Compromise Payment Information
AMOUNT OWED
Total Amount owed to FTB $ ______________ Tax Year(s): __________________________________________________________
OFFER AMOUNT
The lump-sum of $ __________________ is offered in compromise . An FTB representative will instruct you when to mail the offer
amount . Do not send any funds now .
Select which of the following you would like FTB to do if this OIC is denied .
◻ Retain any amounts deposited and credit those amounts to the undersigned’s liabilities .
◻ Return the amount deposited .
SOURCE OF FUNDS
Please provide the source of funds, loan, gift, or other .
a . Please attach the loan agreement and provide the following information if either box has been checked .
◻ Is all of the offer a loan?
OR ◻ Is part of the offer a loan?
Name of Lender Amount Borrowed
b . Please provide the following information if either box has been checked .
◻ Is all of the offer a gift?
OR ◻ Is part of the offer a gift?
Name of Donor Amount of Gift
Donor’s Relationship to You
c . Describe sources of offered funds other than those listed in a or b .
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FTB account number: _________________
Section 9 Statement of Agreement
It is understood this offer will be considered and acted upon in due course, and that it does not relieve you from the liability
sought to be compromised, unless and until the offer is accepted by the Franchise Tax Board and there has been full
compliance with the terms of the agreement, including any collateral agreement .
It is agreed, except for any amounts deposited in connection with this offer, the Franchise Tax Board will keep all payments
and other credits made to your account for the periods covered by this offer, and that the Franchise Tax Board will keep
any and all amounts to which you may be entitled under the Revenue and Taxation Code, due through overpayments of
any tax, penalty or interest, for any periods ending before the end of the calendar year in which this offer is accepted .
It is further agreed, upon the mailing of notice to you of the acceptance of the offer, you shall have no right to contest in
court or otherwise the amount of the liability sought to be compromised . No compromise of any liability in this offer is final,
until all the obligations you have under the compromise agreement and collateral agreement are completely performed .
In the event of a default by you on the compromised agreement, including any collateral agreement, it is agreed that the
Franchise Tax Board may:
• Rescind the compromise .
• Re-establish all compromised liabilities .
• Retain all amounts previously deposited under the offer .
• Proceed to collect the remaining balance of the re-established liabilities .
The compromise agreement may also be rescinded for one or more of the following reasons:
• Failure to disclose any property information .
• Failure to file future required tax returns .
• Failure to pay final tax liabilities timely .
• Providing false records or statements relating to your assets or financial condition, by or on behalf of you or any other
person liable for the tax .
Additionally, I authorize FTB to obtain my consumer credit report and to investigate and verify the information I
provided on this application.
Signature
I hereby certify under penalty of perjury under the laws of California, that all information supplied on this form
including any attachment is true, correct, and complete to the best of my knowledge and ability.
Taxpayer's Signature Date
X
Spouse's/RDP's Signature Date
X
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 Enlarge image | Frequent Topics Fair Offer Generally, an offer will be accepted when the amount offered is the most we can expect to collect within a reasonable period of time . OIC Decision Time Frame Generally, we will have a decision within 120 days of your account being assigned to a specialist . If your account is more complex, it may take longer than 120 days . Payments You cannot make payments toward the offered amount, we require a lump-sum payment of the offered amount . We cannot apply prior payments toward the offered amount . However, we consider prior payments and the offered amount compared to the total liability when evaluating your offer . IRS OIC Accepted We will make a separate determination about whether to accept your offer, independent of the IRS . We Will Contact You about Your OIC We contact you to discuss your account and to determine the most appropriate resolution . For example, if we determine that you will have the ability to make monthly payments that exceed the amount you offer, we will work with you to establish an installment agreement . State Tax Liens We release FTB state tax liens upon final approval of your OIC . Power of Attorney or Representative We do not require that you have representation, but you do have the right to representation . The OIC Program is available to all taxpayers, whether or not they have representation . Bankruptcy If this is a consideration, you may want to seek your own legal advice . However, your application will not be accepted if you are in a current, open bankruptcy . No Funds for OIC We will not accept a zero dollar offer . Your offer must represent the most we can expect to collect over a reasonable period of time and be in the state’s best interest to accept . Collateral Agreement A collateral agreement is a contractual agreement between you and FTB . By signing the agreement, you agree to pledge to us a percentage of your income that exceeds an agreed-upon threshold . Generally, the collateral agreement period is five years . We will make that determination in reviewing your application and financial information provided to us . Generally, we do not require a collateral agreement if you are on a fixed income or have limited potential for an increase in income . OIC for Multiple State Agencies To relieve some of the paperwork burden for taxpayers or their representatives, the state’s three taxing agencies developed a single offer in compromise application . Individual taxpayers can use Multi-Agency Form for Offer in Compromise (DE 999CA) to apply with any or all of the three agencies . Go to edd .ca .gov to locate DE 999CA . FTB 4905 PIT (REV 06-2023) PAGE 16 |
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Franchise Tax Board Privacy Notice on Collection
The privacy and security of your personal information is of the utmost importance to us . We want you to have the highest
confidence in the integrity, efficiency, and fairness of our state tax system .
Your Rights and Responsibilities
You have a right to know what types of information we gather, how we use it, and to whom we may provide it . Information
collected is subject to the California Information Practices Act, Civil Code Sections 1798-1798 .78, except as provided in
Revenue and Taxation Code (R&TC) Section 19570 .
If you meet certain requirements, you must file a valid tax return and related documents . You must provide your
social security number or other identifying number on your tax return and related documents for identification . (R&TC
Sections 18501, 18621, and 18624)
Reasons for Information Requests
We may request additional information to verify and collect the correct amount of tax . (R&TC Section 19504)
You must provide all requested information, unless indicated as “optional .”
Consequences of Noncompliance
We charge penalties and interest if you:
• Meet income requirements but do not file a valid tax return .
• Do not provide the information we request .
• Provide false information .
We may also disallow your claimed exemptions, exclusions, credits, deductions, or adjustments . If you provide false
information, you may be subject to civil penalties and criminal prosecution . Noncompliance can increase your tax liability
or delay or reduce any tax refund .
Disclosure of Information
We will not disclose your personal information unless authorized by law . We may disclose your tax information to:
• The Internal Revenue Service .
• Other states ’income tax officials .
• California government agencies and officials .
• Third parties to determine or collect your tax liabilities .
• Your authorized representative(s) .
If you owe taxes, we may disclose your balance due as part of our collection process to employers, financial institutions,
county recorders, process agents, or other asset holders .
Responsibility for the Records
The director of the Processing Services Bureau maintains Franchise Tax Board’ s records . You may review your records and
bring any inaccuracies to our attention .
You can obtain information about your records by:
Phone: 800 .852 .5711 from 8 a .m . to 5 p .m . weekdays, except state holidays
916 .845 .6500 from outside of the United States
California Relay Service: 711 or 800 .735 .2929 for persons with hearing or speaking limitations
Mail: DISCLOSURE OFFICER MS A181
FRANCHISE TAX BOARD
PO BOX 1468
SACRAMENTO CA 95812-1468
To learn more about our Privacy Policy Statement, go to ftb.ca.gov/privacy .
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