4     6
                                                                                                                                           PRINT   CLEAR
Worksheet for Offer in Compromise - Self-Employed Individuals                                                       Web-fill Form OIC-101C
Must complete OIC-1062 prior to completion of Worksheet

Step 1: Assessing Liquid Assets - Section 3

Cash on Hand - Line 12
Average Bank Balance - Section 3 Line 13e + Section 9 Line 55c
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 and Business Assets Section 9

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)                                                                                                                    F
Less                                                                                                                            Section 8 Line 33

Total Monthly Expenses (Line 43)
Housing and Utilities, Vehicle ownership & operating costs, food & clothing, health & 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