4       6
                                                                                                                                                              PRINT     CLEAR

Worksheet for Offer in Compromise - Individual                                                                                           Web-fill Form OIC-101A
Must complete OIC-1062 prior to completion of Worksheet
Step 1: Assessing Liquid Assets - Section 3

Cash on Hand - Line 12
Average Bank Balance - Line 13e
Investment account balance (stocks, bonds, retirement) - Line 14d
Cash value of insurance policy - Line 15c
TOTAL LIQUID ASSETS                                                                                                                                                    A

Step 2: Real Property - Section 4

County Tax Value                             x  80%              - Loan Balance                                                        = Asset Value                   B
                          Section 4 Line 16c    QSV                                                                  Section 4 Line 16d
Step 3: Purchased Vehicle/Other LIcensed Asset - Section 5

NADA Value                                   x  80%              - Loan Balance                                                        = Asset Value                   C
                          Section 5 Line 17c    QSV                                                                  Section 5 Line 17d

Step 4: Subtracting Judgements/Liens - Section 7
                                                                                                                                         Balance due                   D
                                                                                                                                                     Section 6 Line 18d

Step 5: Total Equity in Assets Held 
                                                                                                                                                                       E
                                                                                                                                                     (A+B+C)-D = E

Step 6: Disposable Income Analysis - Section 10
Total Monthly Income (line 33)
Wages, pensions, Social Security, dividends, profit from business, alimony child support, commissions, other                                                           F
                                                                                                                                                     Section 8 Line 33
Less
Total Monthly Expenses (line 43)
Housing and utilities, vehicle ownership and operating costs, food and clothing, health and life insurance, out-of-pocket
medical, alimony, child support, and other court-ordered payments, child care, tax payments                                                                            G
                                                                                                                                                     Section 8 Line 43

Disposable Monthly Income:                                                                                                                                             H
                                                                                                                                                     F-G = H

Step 7: Proposed Offer Amount 
** Do not enter amounts below $0.00.  If equity in assets   disposable income calculations or
are less than $0.00, enter $0.00.

Equity in Assets Held (E)                                                                                                                                              I

Disposable Monthly Income (H)                                        x                                   36 (months)                                                   J
                                                                                                                                                     H x 36

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