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OIC 100                        NORTH CAROLINA DEPARTMENT OF REVENUE                                            PRINT       CLEAR
Web-Fill
   3-19                             OFFER IN COMPROMISE
1) Name and Address of Taxpayer(s)

   Name                                                                   Date

   Trading As                                                             Account ID 

   Address                                                                SSN/FEIN 

   City                                              State                Zip Code

2) Outstanding Liability
   Mark an “X” in the box for the correct tax type.  Fill in the corresponding tax period(s) and amount(s) due.
   Tax Type                                       Period (s)                         Amount of Liability* 
   Individual Income 

   Sales & Use

   Withholding

   Other (specify) 

   *Include tax, penalty, and interest.                           TOTAL    $

3) Basis For Compromise:  (G.S. 105-237.1 authorizes compromises in the following situations.  Mark an “X” in the
                         appropriate box(es).) 
   There is reasonable doubt as to the amount of the liability of the taxpayer under the law and the facts.
   The taxpayer is insolvent and the Secretary probably could not otherwise collect an amount equal to or in excess of the amount 
   offered in compromise.  A taxpayer is considered insolvent only in one of the following circumstances.  (check one):
        a. It is plain and indisputable that the taxpayer is clearly insolvent and will remain so in the reasonable future.
        b. The taxpayer has been determined to be insolvent in a judicial proceeding.
   Collection of a greater amount than that offered in compromise is improbable, and the funds or a substantial portion 
   of the funds offered in the settlement come from sources from which the Secretary could not otherwise collect.
   A federal tax assessment arising out of the same facts has been compromised with the federal government on the 
   same or a similar basis as that proposed to the State and the Secretary probably could not collect an amount equal 
   to or in excess of that offered in compromise. 
   Collection of a greater amount than that offered in compromise would produce an unjust result under the circumstances.
   The taxpayer is a retailer or a person under Article 5 of this Chapter; the assessment is for sales or use tax the retailer 
   failed to collect or the person failed to pay on an item taxable under G.S. 105-164.4(a)(10) and (a)(11), and the retailer 
   or person made a good-faith effort to comply with the sales and use tax laws.  This subdivision expires for assessments 
   issued after July 1, 2020.
   The assessment is for sales tax the taxpayer failed to collect or use tax the taxpayer failed to pay as a result of the change 
   in the definition of retailer or the sales tax base expansion to (i) service contracts, (ii) repair, maintenance, and installation 
   services, or (iii) sales transactions for a person in retail trade. The Secretary must determine that the taxpayer made a 
   good-faith effort to comply with the sales and use tax laws. This subdivision applies to assessments for any reporting period 
   beginning March 1, 2016, and ending December 31, 2022.

4) Has any period listed above been compromised with the Internal Revenue Service?   _________ If yes, attach a
   copy of the agreement.

5) Amount of Offer:

see page 2 



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Page 2, OIC 100, Web-Fill, 3-19

6)  20% Down Payment:                        (Must be in certified funds)
                                20% x Line 5

7)  Sources of Funds: 
                                   If source of funds is “third party”, attach OIC-102.

8)  Explanation of Circumstances

 I am requesting an offer in compromise for the reason(s) listed below:

      Note:  If you are requesting a compromise based on doubt as to liability, explain why you do 
      not believe you owe the tax.  If you think you have special circumstances affecting your 
      ability to fully pay the amount due, explain your situation.  You may attach additional 
      sheets if necessary.

 *  I declare that to the best of my knowledge and belief this statement of assets, liabilities, and other information is true, correct and complete. 
       
 Signature

      Date

 Telephone No. 






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