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  Missouri Department of Revenue

  Offer in 

  Compromise 

 This book includes all of the following to guide taxpayers 
  through the Offer in Compromise process.

   Offer in Compromise policy statement.

    Information you need to know before submitting an  
  Offer in Compromise. 

    Instructions for completing the Offer in Compromise.

    Offer in Compromise Application MO-656.

    Terms and Conditions for the Offer in Compromise.

    Offer in Compromise documentation checklist.  

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What is an Offer in Compromise?
The Department is authorized to consider an Offer in Compromise under Section 32.378, RSMo. An Offer in Compromise
allows qualifying taxpayers an opportunity to settle unpaid tax accounts for less than the full amount that is owed. The goal
of the Offer in Compromise program is to resolve a liability in a way that is in the best interest of both the State of Missouri
and the taxpayer.
An offer based on doubt as to collectibility or severe economic hardship is not automatically accepted due to an immediate
financial inability to pay. The Department will review the taxpayer’s financial situation and will estimate how much can be
collected over time if the offer is not accepted.
If taxpayers are unable to pay their taxes in full, there are other payment options, such as monthly installment agreements,
that must be explored before an Offer in Compromise is submitted.
What can an Offer in Compromise do for me?
- Provide a “fresh start” towards tax compliance
- Resolve tax debt for less than the amount owed
- Remove economic burdens of state tax liens and levies
What can an Offer in Compromise not do for me?
- Delay or cancel existing collection actions. If it is determined that the offer was filed to delay collections, the offer will
likely be rejected.
- Void or abate existing tax liabilities without any offer of payment or reason for a compromise.
- Release of lien, levy or other enforced collection until the offer is accepted.
What are some reasons an offer may be rejected?
- An offer of ‘zero’ or ‘none’ will not be considered for doubt as to collectibility.
- The taxpayer fails to make full financial disclosure, including all household income.
- There is evidence that assets were transferred or sold for less than the market value.
- The taxpayer submits false or misleading information.
- The taxpayer has not fully filed all tax types.
- The taxpayer has repeated noncompliance or attempts to avoid paying tax obligations.
- The offer does not include a statement supporting the reason for the offer.
- The offer includes an amount already collected.
- The tax liability sought to be compromised directly relates to a crime for which the taxpayer has plead guilty or was
found guilty.
What is the criteria for submitting an offer?
1. Doubt as to liability:
a.) Must complete Section 1 of the MO-656
b.) Must provide a written statement explaining why the liability is not owed
2. Doubt as to Collectibility:
a.) Must be fully filed on all required years for all tax types.
b.) Must not have an open bankruptcy proceeding.
c.) Must be current on all estimated tax payments if the taxpayer is required to make estimated tax payments.
d.) Offer in Compromise payment plans must be through Electronic Funds Transfer (EFT) or credit card.
e.) The taxpayer must submit all required information listed on the Offer in Compromise checklist.
f.) Must complete Sections 1 through 5 of the MO-656. If self-employed or own a business; must complete
Sections 1, 2, and 4 through 8.
3. Effective Tax Administration; Severe Economic Hardship:
a.) Must be fully filed on all required tax years for all tax types.
b.) Must not have an open bankruptcy proceeding.
c.) Must be current on all estimated tax payments if the taxpayer is required to make estimated tax payments.
d.) Offer in Compromise payment plans must be through Electronic Funds Transfer (EFT) or credit card.
e.) Must complete Sections 1 through 5 of the MO-656. If self-employed or own a business; must complete
Sections 1, 2,and 4 through 8.
4. Effective Tax Administration; Exceptional Circumstances:
a.) Must complete Section 1 of the MO-656.
b.) Must provide a written statement explaining circumstances.

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Is professional assistance required to submit an offer?
Taxpayers are welcome to seek tax assistance from a tax professional, but it is not a requirement.

How does the Offer in Compromise process work?
When the Department receives a taxpayer’s offer, it is reviewed to determine if all of the required documentation has been
submitted and all criteria for submitting an offer have been met. If all documentation is not submitted, documentation is not
complete, or if the MO-656 forms are not signed and dated, a letter will be sent requesting additional information. Each
offer is considered on an individual basis and can be submitted for one of the following reasons:
1. Doubt as to Liability (I do not believe I owe this tax.): The taxpayer or entity must provide sufficient documentation
to establish that there is substantial doubt regarding the taxpayer’s liability and reasonable cause for failure to produce
such documentation earlier in the collection process.
2. Doubt as to Collectibility (I agree I owe the tax, but cannot pay.): The taxpayer or entity must provide documentation
that demonstrates an inability to pay the liability in full. The amount offered must be the maximum amount the
taxpayer can pay, taking into consideration future earning potential and total equity in all assets.
3. Effective Tax Administration:
(a) Severe Economic Hardship - Collection of the full liability will result in severe economic hardship to the taxpayer.
If the Offer in Compromise is based on this reason, the Offer in Compromise Application (MO-656) with the
applicable sections completed must be included.
(b) Exceptional Circumstances - Regardless of the taxpayer’s financial circumstances, exceptional circumstances
exist that make collection of the full amount detrimental to voluntary compliance include, but are not limited to;
(i) the taxpayer failed to pay because of circumstances beyond the reasonable control of the taxpayer and not the
result of negligence on the part of the taxpayer or;
(ii) a reasonable person would not expect the assessment based on previous policy of the Department of Revenue
or information provided to the taxpayer by the Department of Revenue.

What happens when a decision is made?
When a decision is made, the taxpayer will be notified in writing. If the offer is accepted, the taxpayer must remain
compliant on all Missouri tax filings and payment requirements for three years from the date the offer is accepted. If the
taxpayer does not remain compliant, the negotiated amount will be retracted and the original balance due plus additional
interest, less payments made, will then be owed. The Department will also offset state and federal refunds for tax periods
through the tax year that the offer is accepted. An offset does not reduce the accepted Offer in Compromise amount.
Once an offer is accepted and paid according to the terms of the offer, any enforced collection activity such as liens and
levies issued against the taxpayer who submitted the offer will be released. Failure to remain in compliance will result in
the default of the offer and the Department will require payment of the original balance due plus additional interest, less
payments made.
The law does not provide for an appeal of a rejected offer. The taxpayer must make payment arrangements to pay the
debt. If this is not done, the case will be referred for further collection actions to collect the debt in full.

Where do I submit the offer?
Collections Enforcement
P.O. Box 1646
Jefferson City MO 65105-1646
Phone (573) 751-7200
Fax (573) 522-3218

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Before completing MO-656, please make sure you are The Offer
eligible for the Offer in Compromise based on one of the Enter the amount you can offer. Offer must be more than
reasons listed below. zero if the offer is based on doubt as to collectibility.
If you require additional pages for any information you are Check cash offer if the amount is to be paid within 30 days
providing, attach them as needed. after written notice of acceptance of the offer. Check short-
term deferred payment offer if the amount will be paid in
Section 1: Personal Information more than 30 days.
Print or type your name(s), social security number(s), date Indicate if you are borrowing the settlement offer. If so,
of birth, dependent information, and address in the spaces provide the lender’s information in the spaces provided.
provided.
If you choose doubt as to collectibility or severe economic
A reason this offer is being submitted must be indicated by hardship for the reason for your offer, you must include an
checking a box. explanation of why you are unable to pay your balance in full.
Doubt as to Liability
A legitimate doubt exists that the assessed liability is correct. Section 3: Employment Information
Possible reasons to submit a doubt as to liability offer include: Enter name of employer(s), phone number(s), address, year
1. You dispute the existence or amount of the correct tax or months employed, occupation(s), number of allowances
liability. claimed on W-4, and how often you are paid.
2. Your evidence was not considered. If you or your spouse are self-employed or own your own
business also complete sections 6-8.
3. You have new evidence.
If doubt as to liability is chosen, only Sections 1 and 2 are Section 4: Personal Financial Information
required. Bank Accounts
Doubt as to Collectibility Include IRA’S, other retirement plans, certificates of deposit,
Doubt exists that you could ever pay the full amount of tax etc. Attach all pages of the most recent three months of
liability owed. If the offer in compromise is made for this bank statements for all accounts of each person in the
reason, you must complete Sections 1 through 5 for an household. If you owe more than $50,000, attach the most
individual or if self-employed or you own a business recent six months of bank statements.
complete Sections 1, 2 and 4 through 8. Enter the name of the institution(s), address, type of account(s),
Effective Tax Administration (checking, saving, IRA, etc.), date the account was opened,
(a) Severe Economic Hardship - Collection of the full liability account number(s), and the balance of the account.
will result in severe economic hardship to the taxpayer. Personal Property
If the Offer in Compromise is made for this reason, you Include boats, automobiles, ATV’s, motorcycles, recreational
must complete Sections 1 through 5 for an individual or vehicles, airplanes, machinery, etc, not used in your business.
if self-employed or you own a business complete Attach additional pages as needed.
Sections 1, 2 and 4 through 8.
Enter year, make, model or style, license number, lender or
(b) Exceptional Circumstances - Regardless of your financial
lien holder, current market value, current payoff, and available
circumstances, exceptional circumstances exist such
equity. Enter zero if equity is less than zero. Attach copies of
that collection of the full liability will be detrimental to
loan statements including the current payoff.
voluntary compliance by the taxpayer. Such exceptional
circumstances include, but are not limited to: Real Property
For each property enter description, county, parcel number,
(i) Instances where the failure to pay the taxes assessed
mortgage lender’s name and address, current market value,
is the result of circumstances beyond your reasonable
loan balance, and available equity. Include name of owner as
control and is not the result of negligence on your part
it appears on the deed, purchase price, and the date. Attach
or
supporting documentation of the loan balance and your most
(ii) Instances in which a reasonable person would not recent real personal property tax receipt for each property.
expect the assessment based onprevious policy of
the Department of Revenue or information provided Other Valuable Items
to you by the Department of Revenue. Include artwork, guns, collectibles, jewelry, and any other
valuable items not previously listed. Enter item, description,
If exceptional circumstances is chosen, only Sections 1 and
and current market value.
2 are required.
Credit Cards and Unsecured Lines of Credit
Section 2: Payoff Information Enter type of credit, name of creditor, record owner, balance
Tax Type owed, and available credit. Attach supporting documentation
Indicate each tax type with a balance due by checking of balances owed.
the box. Enter social security number or business tax iden-
tification number and periods for each tax type marked.
All Missouri tax debt must be included in the settlement offer.

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Life Insurance Real Property
Enter name of insurance company, agent name and For each property, enter description, county, parcel number,
telephone number, policy number, type of insurance, face mortgage lender’s name and address, current market value,
amount, and loan or cash surrender value. Include copies of loan balance, and available equity.
life insurance policies. Include name of owner as it appears on the deed, purchase
price, and date. Attach supporting documentation of loan
Securities
balance and most recent property tax receipt for each property.
Include stocks, bonds, mutual funds, money market funds
and 401(k), not previously listed. Enter type of security, Other Valuable Items
location, record owner, quantity or denomination, and current Include cash, accounts receivable, artwork, collectibles, and
value. Attach supporting documentation showing current any other valuable items not previously listed. Enter item,
value of each. description, and current market value.
Securities
Other Financial Information
Include stocks, bonds, mutual funds, money market funds and
Indicate no or yes for the options in this section. If “yes” is
401(k), not previously listed. Enter the type of security, location,
checked provide dates, explanation, and documentation.
record owner, quantity or denomination, and current value.
Transferred assets may include any vehicles, equipment,
Attach supporting documentation and additional pages as
and property sold, given away, donated, or repossessed in
needed.
the last 12 months.
Business Credit Cards and other Lines of Credit
Section 5: Personal Income and Expense Analysis Enter the type of credit, name of the creditor, record owner,
Enter gross monthly income. Under other, include income balance owed, and available credit. Attach supporting
contributed by others in the household. Enter monthly documentation of balances owed.
expenses for each category that applies. Attach proof of
Other Financial Information
monthly living expenses such as receipts, utility bills, tax
Indicate no or yes for the options in this section. If “yes” is
payments, etc. Subtract total living expenses from total
checked provide dates, explanation, and documentation.
monthly income to obtain total disposable income.
Transferred assets include vehicles, equipment, and
Stop Here! property sold, given away, donated, or repossessed in the
Complete sections 6-8 only if you own a business or you are last 12 months.
self employed. Otherwise skip to Section 9.
Section 8: Business Income and Expense Analysis
Section 6: Business Information
Choose the accounting method used and enter the
Enter business name, Missouri tax identification number, dates for income and expenses. Enter gross monthly
business address, telephone number, and website. Select income and monthly business expenses for each category
the type of business and give a description of the business. that applies. Attach proof of monthly business expenses
Enter the average gross monthly income and average and total monthly income.
number of employees for the past 12 months. If you or
Before submitting your offer read the terms and conditions
your spouse own additional businesses, complete an
in Section 9.
additional attachment with the information for each business.
Section 9: Signatures
Section 7: Business Financial Information
Signatures and dates are required for your offer to be
Bank Accounts
considered. If the MO-656 is sent without signatures and
Include certificates of deposit, etc. Attach all pages of the
dates the offer will be deemed invalid.
most recent three months bank statements for each account.
If you owe more than $50,000, attach the most recent six
months of bank statements. Attach additional pages as
needed.
Personal Property
Include automobiles, boats, ATV’s, motorcycles, recreational
vehicles, airplanes, machinery, and equipment owned by or
used in your business.
Enter year, make, model or style, license number, lender or
lien holder, current market value, current payoff, and
available equity. Enter zero if equity is less than zero. Attach
copies of loan statement including current payoff.

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0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 80 
1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 52 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 51 
      0 0 0  4 4 4 4 0                                                                                          Department Use Only
      0 0 0  5 5 5 5 0     Form         Missouri Department of Revenue                                          (MM/DD/YY)
      0 0 0  6 6 6 6 0     MO-656       Offer in Compromise Application
      0 0 0  7 7 7 7 0 
      0 0 0  8 8 8 8 0 
      0 0 0  9 9 9 9 0 
      1 1 1  0  0  0  0  1 
      1 1 1  1 1 1 1 1 
      1 1 1  2 2 2 2 1 
      1 1 1  3 3 3 3 1     Taxpayer                                                                 Social Security
      1 1 1  4 4 4 4 1     Name                                                                     Number
      1 1 1  5 5 5 5 1 
      1 1 1  6 6 6 6 1                                                                              Spouse’s Social 
                           Spouses                                                                  Security  
      1 1 1  7 7 7 7 1     Name                                                                     Number
      1 1 1  8 8 8 8 1 
      1 1 1  9 9 9 9 1 
      2 2 2  0 0 0 0 2     Business
      2 2 2  1 1 1 1 2     Name
      2 2 2  2 2 2 2 2 
      2 2 2  3 3 3 3 2     Missouri Tax I.D.                                                        Federal Employer
      2 2 2  4 4 4 4 2     Number                                                                   I.D. Number
      2 2 2  5 5 5 5 2 
      2 2 2  6 6 6 6 2     Charter
      2 2 2  7 7 7 7 2     Number
      2 2 2  8 8 8 8 2 
      2 2 2  9 9 9 9 2 
      3 3 3  0 0 0 0 3     Taxpayer Date of Birth(MM/DD/YYYY)      Spouse’s Date of Birth(MM/DD/YYYY)         Marital Status
      3 3 3  1 1 1 1 3     ___ ___ / ___ ___ / ___ ___ ___ ___     ___ ___ / ___ ___ / ___ ___ ___ ___              Married          Unmarried (Single, Divorced, or Widowed)
      3 3 3  2 2 2 2 3     Other Names or Aliases Used                                       Spouses Other Names or Aliases Used
      3 3 3  3 3 3 3 3 
      3 3 3  4 4 4 4 3 
      3 3 3  5 5 5 5 3 
      3 3 3  6 6 6 6 3     Provide information for all other persons in the household and claimed as a dependent.  Attach additional pages as needed.  (This information is 
                           optional if offer is based on doubt as to liability or exceptional circumstances).
      3 3 3  7 7 7 7 3 
      3 3 3  8 8 8 8 3     Section 1 - Personal InformationName                   Age                  Relationship            Claimed as a Dependent    Contributes to  
                                                                                                                                on your Form 1040?      Household Income?
      3 3 3  9 9 9 9 3 
      4 4 4  0 0 0 0 4                                                                                                               Yes No                  Yes No
                                                                                                                                                         
      4 4 4  1 1 1 1 4 
      4 4 4  2 2 2 2 4                                                                                                               Yes No                  Yes No
      4 4 4  3 3 3 3 4 
      4 4 4  4 4 4 4 4                                                                                                               Yes No                  Yes No
      4 4 4  5 5 5 5 4     Your Current Street Address                            City                                         State     ZIP Code       County
      4 4 4  6 6 6 6 4 
      4 4 4  7 7 7 7 4     E-Mail Address                                                                Phone Number                        Secondary Phone Number
                            (__ __ __)__ __ __-__ __ __ __                                                                                   (__ __ __)__ __ __-__ __ __ __
      4 4 4  8 8 8 8 4     Your Mailing Address (If Different From Above)                                City                                     State  ZIP Code 
      4 4 4  9 9 9 9 4 
      4 4 4  0 0 0 0 4     Name of your Tax Representative (CPA, Attorney, Etc.)  Attach POA Form 2827   Phone Number                    Fax Number
      5 5 5  1 1 1 1 5      (__ __ __)__ __ __-__ __ __ __                                                                               (__ __ __)__ __ __-__ __ __ __
      5 5 5  2 2 2 2 5     Tax Representative’s Address                                                  City                                     State      ZIP Code
      5 5 5  3 3 3 3 5 
      5 5 5  4 4 4 4 5     I submit this offer for the reason selected below:  See instructions for explanation of reasons.  (select one)
      5 5 5  5 5 5 5 5                 Doubt as to Liability       Doubt as to Collectibility          Severe Economic Hardship              Exceptional Circumstances
      5 5 5  6 6 6 6 5 
      5 5 5  7 7 7 7 5 
      5 5 5  8 8 8 8 5 
      5 5 5  9 9 9 9 5 
      5 5 5  0 0 0 0 5 
      6 6 6  1 1 1 1 6 
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      6 6 6  4 4 4 4 6 
      6 6 6  5 5 5 5 6                                                                             6
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Tax Type Social Security Number or Tax Periods
Business Identification Number

Personal Income Tax

Business Tax (Withholding, Sales, Use, Corporate)
Other (Explain)
I offer to pay $ _________________________________.  (Must be more than zero if offer is due to doubt as to collectibility)
Select one of the following:      Cash offer    Balance to be paid in:     10  day    30 days
   Short-term deferred payment offer (monthly payments beginning within 30 days of acceptance of the offer)
$ ____________________ within 30 days
$ ____________________ on the ____________________ day of each month starting the second month after written notice of acceptance of 
the offer for a total of ____________________ months.
Will you borrow the settlement offer amount?      Yes     No
If yes, provide the lender’s name, address, phone; list all collateral, if any, pledged to secure the loan.

Lender Information
Name  Phone Number 
   (__ __ __)__ __ __-__ __ __ __ 
Mailing Address City  State ZIP Code  
Section 2 - Payoff Information  
Collateral  Is lender a member of your household or immediate family?
   Yes  No

Include an explanation of why you are requesting an offer in compromise.

If self employed or own a business, complete Sections 6-8.
Name of Employer (Taxpayer) Phone Number How Long Employed
 (__ __ __)__ __ __-__ __ __ __ _______ Years    _______ Months
Address City State ZIP Code 

Occupation Number of Allowances  Paid  Weekly Every 2 Weeks     Monthly Twice Monthly 
 Claimed on Form W-4     (e.g., 1st & 15th)
Name of Employer (Spouse) Phone Number How Long Employed
 (__ __ __)__ __ __-__ __ __ __ _______ Years    _______ Months
Address City State ZIP Code 

Occupation Number of Allowances  Paid Weekly Every 2 Weeks     Monthly Twice Monthly 
 Claimed on Form W-4     (e.g., 1st & 15th)

Additional Employment
Name of Employer  Phone Number How Long Employed
Section 3 - Employment Information 
 Taxpayer  Spouse (__ __ __)__ __ __-__ __ __ __ _______ Years    _______ Months
Address City State ZIP Code 

Occupation Number of Allowances  Paid Weekly Every 2 Weeks   Monthly Twice Monthly   
 Claimed on Form W-4      (e.g., 1st & 15th)

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Bank Accounts: Include IRA’s, other retirement plans, certificates of deposit, etc. Attach all pages of the most recent three months bank
statements for all accounts of each person in the household. Attach additional pages as needed. If you owe more than $50,000, six months
bank statements are required.
Provide information for all persons in the household or claimed as a dependent.
Name of Institution Address Type Date Opened Account Number Balance

Total of all bank accounts with positive balance .....................................................

Personal Property: Include automobiles, boats, ATV’s, motorcycles, recreational vehicles, airplanes, machinery, etc., not used in your
business. Attach additional pages as needed. Attach supporting documentation of payoff.
Available Equity
Year Make Model License Number Lender or Lienholder Current Market Value Current Payoff (cannot be less than 0)

Total equity of all personal property ........................................................

Real Property: For each property, include copies of deed, homeowner’s or renter’s insurance policy with riders, supporting documentation of
loan balance, and most recent property tax statement. Attach additional pages as needed.
Property 1
Section 4 - Personal Financial Information Physical Address and Description County Parcel Number
(Single Family Home, Multi-Family Home, Bare Lot, Acreage, etc.)

Mortgage Lender’s Name and Address Current Loan Value Available
Market Value Balance Equity

Name(s) of Owners on Deed Purchase Price Purchase Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Property 2
Physical Address and Description County Parcel Number
(Single Family Home, Multi-Family Home, Bare Lot, Acreage, etc.)

Mortgage Lender’s Name and Address Current Loan Value Available
Market Value Balance Equity

Name(s) of Owners on Deed Purchase Price Purchase Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

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Other Valuable Items: Include items such as artwork, guns, collectibles, jewelry. Attach additional pages as needed.
Item Description Current Value

Total value of all other valuable items .........................................................

Personal credit cards and unsecured lines of credit.
Type Name of Creditor Record Owner Balance Owed Available Credit

Total unsecured credit balance amount .......................................................

Life Insurance: Attach additional pages as needed. Attach supporting documentation.
Name of Agent’s Name and Policy Number Type Face Amount Loan or Cash
Insurance Company Telephone Number Surrender Value

Total value of all life insurance policies ........................................................

Securities: Include stocks, bonds, mutual funds, money market funds, 401(k), etc. Attach additional pages as needed.
Attach supporting documentation for the most recent three months.
Type Location Record Owner Quantity or Current Value
Denomination

Section 4 - Personal Financial Information
Total value of all securities .................................................................

Other Financial Information. If you check “yes”, provide dates, an explanation, and documentation. Attach additional pages as needed.

Court proceedings (litigation, probate, etc.). . . . . . . . . . . . . . . . . . . . . No Yes ______________________________________

Anticipated increase in income .............................. No Yes ______________________________________

Bankruptcies or receiverships ............................... No Yes ______________________________________

Transfer of assets in last 12 months .......................... No Yes ______________________________________

Beneficiary to trust, estate, profit sharing, etc ................... No Yes ______________________________________

Taxes owed to the IRS (provide proof). ........................ No Yes ______________________________________

Taxes owed to other states, counties, districts, agencies, etc. . . . . . . No Yes ______________________________________

Other debt (explain) ....................................... No Yes ______________________________________

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Monthly household disposal income. Attach documentation.
Gross Monthly Income Monthly Living Expenses
Source Taxpayer Spouse Source Amount
Salary, Wages, Commissions, Tips House or Rent Payment
Self-Employment Income Income Taxes (Federal, State, FICA)
Pensions, Disability & Social Security Estimated Tax (If Applicable)
Dividends & Interest Groceries
Gift or Loan Proceeds Medical Expenses & Prescriptions
Rental Income Utilities:
Estate, Trust & Royalty Income Electric  $ ____________ + Gas $ ____________ +
Workers’ Comp. & Unemployment Water $ ____________ + Phone  $ ____________ =
Alimony & Child Support Insurance:
Seller Carried Contracts Life $ ____________ + Health  $ ____________ +
Sales Auto $ ____________ + Home  $ ____________ =
Other (Specify) Court Ordered Payment
Court Ordered Settlement Personal Loan Payment
Restitution Clothing & Personal Grooming
Legal Fees
Transportation Expense
Vehicle Loan or Lease Payment
Property Taxes
Child Care
Installment & Credit Card Payments
Section 5 - Personal Income and Expense Analysis 
Tuition Payment
Other (Specify)

Subtotal    
Combined Monthly Income Total Monthly Living Expenses
Net Monthly Household Disposable Income
(“Combined Monthly Income” minus “Total Monthly Living Expenses”) ......................................................

Complete sections 6 through 8 only if you own a business or are self-employed.

Business Name Missouri Tax Identification Number Average Gross Monthly Income Total Employees

Business Address Business Telephone Number Business Website
 (__ __ __)__ __ __–__ __ __ __
City State  ZIP Do you or your spouse have any other business interests? 
Type of Business (Select One)  Yes  No
 Sole Ownership      Partnership       LLC      Corporation    Other If Yes, complete additional attachment for each 
business interest. 
Description of Business

Section 6 - Business Information

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Bank Accounts: Include certificates of deposit, etc. Attach all pages of the most recent three months bank statements for all accounts.
Attach additional pages as needed. If you owe more than $50,000, six months bank statements are required
Name of Institution Address Type Date Opened Account Number Balance

Total of all bank accounts with positive balance .....................................................

Personal Property: Include automobiles, boats, ATV’s, motorcycles, recreational vehicles, airplanes, machinery, etc., not used in your business.
Attach additional pages as needed. Attach supporting documentation of payoff.
Available Equity
Year Make Model License Number Lender or Lienholder Current Market Value Current Payoff (cannot be less than 0)

Total equity of all personal property ........................................................

Real Property: For each property, include copies of deed, homeowner’s or renter’s insurance policy with riders, supporting documentation of
loan balance, and most recent property tax statement. Attach additional pages as needed.
Property 1
Physical Address and Description County Parcel Number
(Single Family Home, Multi-Family Home, Bare Lot, Acreage, etc.)

Mortgage Lender’s Name and Address Current Loan Value Available
Market Value Balance Equity

Name(s) of Owners on Deed Purchase Price Purchase Date (MM/DD/YYYY)
Section 7 - Business Financial Information __ __ /__ __ /__ __ __ __

Property 2
Physical Address and Description County Parcel Number
(Single Family Home, Multi-Family Home, Bare Lot, Acreage, etc.)

Mortgage Lender’s Name and Address Current Loan Value Available
Market Value Balance Equity

Name(s) of Owners on Deed Purchase Price Purchase Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Other Valuable Items: Include cash, accounts receivable, artwork, collectibles, business equipment, and any other valuable items.
Attach additional pages as needed. Attach supporting documentation.
Type Location Record Owner Quantity or Current Value
Denomination

Total value of all valuable items .............................................................

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Total value of all securities .................................................................

Business credit cards and unsecured lines of credit.
Type Name of Creditor Record Owner Balance Owed Available Credit

Total unsecured credit balance amount .......................................................

Other Financial Information. If you check “yes”, provide dates, an explanation, and documentation. Attach additional pages as needed.

Court proceedings (litigation, probate, etc.). . . . . . . . . . . . . . . . . . . . . No Yes ______________________________________

Anticipated increase in income .............................. No Yes ______________________________________
Section 7 - Business Financial Information
Bankruptcies or receiverships ............................... No Yes ______________________________________

Transfer of assets in last 12 months .......................... No Yes ______________________________________

Beneficiary to trust, estate, profit sharing, etc ................... No Yes ______________________________________

Taxes owed to the IRS (provide proof). ........................ No Yes ______________________________________

Taxes owed to other states, counties, districts, agencies, etc. . . . . . . No Yes ______________________________________

Other debt (explain) ....................................... No Yes ______________________________________

Accounting Method Used Cash Accural
Income and expenses during the period (MM/DD/YYYY) __ __ /__ __ /__ __ __ __ to __ __ /__ __ /__ __ __ __
Total Monthly Business Income Total Monthly Business Expense
Source Gross Monthly Expense Items Actual Monthly
Gross Receipts from Sales and Services Materials Purchased
Gross Rental Income Inventory Purchased
Interest Income Gross Wages & Salaries
Dividends Rent
Cash Supplies
Other Income (specify below) Utilities and Telephone
Vehicle Gasoline and Oil
Repairs & Maintenance
Insurance
Current Taxes
Section 8 - Business Income and Expense Analysis
Other Expenses (specify)
Total Income Total Expenses

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1. I will remain in compliance with all tax types for three years after acceptance of the offer.
2. The offer remains pending until an authorized Department official issues notification of acceptance
or rejection, or until the offer is withdrawn by me.
3. I understand that I voluntarily submit any payment made with this offer.
4. If the Department rejects the offer or if the offer is withdrawn, the Department will treat any paid
amount with the offer as payment toward the outstanding tax liability.
5. Collection activity is normally suspended while an offer is pending, but such suspension is not
required by law. I further understand that collection activity may continue if it is determined to be in
the state’s best interests, or if it is otherwise determined that the filing of the offer has not been made
in good faith.
6. The Department will retain any payment(s) toward the liability for which the offer is made if such
payment was made prior to receipt of the offer by the Department. The Department will retain and
apply all amounts due to refund offset when such amounts are received prior to full payment of an
accepted offer. An offset does not reduce the accepted Offer in Compromise amount.
7. I understand that the tax I owe is, and will remain, a tax liability until I meet all the terms and conditions
of the offer. If I file bankruptcy before the terms and conditions of the offer are completed, any claim
the Department files will be for the full amount less any payments.
8. Once the Department accepts the offer in writing, I have no right to contest, in court or otherwise,
the amount of tax liability.
Terms and Conditions
9. I the taxpayer shall bear all of my own costs, including attorney fees.
10. If I fail to meet the terms and conditions of an accepted offer, the compromise will be considered
null and void. Updated interest and penalties will be added to the total balance due until paid in full.
In addition the Department may:
• Immediately issue and record any tax liens necessary to protect the state’s legal interest;
• Proceed with enforced collection of the total outstanding liability;
• Apply amounts already paid under the offer to the total liability.

I agree to be bound by all the terms and conditions set forth in this offer. Under penalties of perjury, I declare that I have
examined this offer, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under
federal law and that I am not eligible for any tax exemption, credit, or abatement if I employ such aliens.

Taxpayer Signature Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
Signature of Taxpayer Spouse or Partner Date (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __

On behalf of the Missouri Department of Revenue, I accept the offer to pay for the reasons listed in Section 2.

Signature of Authorized Department Official Title Date (MM/DD/YYYY)
Office USe Only __ __ /__ __ /__ __ __ __
Form MO-656 (Revised 08-2017)
Mail to: Taxation Division Phone: (573) 751-7200
P.O. Box 1646 Fax: (573) 522-3218 Visit http://www.dor.mo.gov/
Jefferson City, MO 65105-1646 TTY: (800) 735-2966 for additional information.
E-mail: collections@dor.mo.gov

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Offer in Compromise Checklist

  Form MO-656 Offer in Compromise (enclosed)

  Third Party Affirmation – Power of Attorney Form 2827 (If Applicable)
For all Offers
  Supporting Documentation

  Proof of gross earnings, pension, social security, and other income, including statements showing  
 deductions for the past three months

  Copies of bank statements for all checking and savings accounts, personal and business, for the 
 most recent three months (If balance owed is $50,000 or more include most recent six months of  
 bank statements)

  Copies of federal income tax return for the two most recent years

 Copies of expenses including rent, insurance, and property taxes for the most recent three months 

  Copies of statements for all mortgages of real estate you own or have interest in

 Copies of statements showing the value of your interest in all retirement accounts, pensions, and  
 profit sharing plans for the most recent three months

  A list of all stocks, bonds, and other securities you own, along with the current market value for each

  A statement from the insurance company for each life insurance policy showing the current cash  
 loan value, accumulated dividends and interest, date, and amount of policy, and the amount if there  
 is a loan or cash surrender value

  A statement from lending institutions and other creditors that clearly indicates current balances  
 owed, and payment schedules on all notes payable and revolving accounts

For Offers of Doubt ss to Collectibility and Economic Hardship   Copies of any judgments or legal decrees (excluding bankruptcies) for the most recent two years

  A list of all accounts receivable, showing the payer, amount due, age, and status of each business  
 account

  Copies of medical bills showing a balance still owed not covered by insurance and documentation  
 from the insurance company indicating the items not covered

  List of all business equipment and other business assets, including current market value of each item

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