Form Oic-1 - Offer In Compromise Page 2
Download a blank fillable Form Oic-1 - Offer In Compromise in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Oic-1 - Offer In Compromise with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Print
Clear
Section 3
Reason for Offer
(Continued)
Explanation of Circumstances (Add additional pages, if needed)
The Georgia Department of Revenue understands that there are unplanned events or special circumstances, such as serious illness, where paying the full
amount or the minimum offer amount might impair your ability to provide for yourself and your family. If this is the case and you can provide documentation
to prove your situation, then your offer may be accepted despite your financial profile. Describe your situation below and attach appropriate documents to
this offer application.
Section 4
Low Income Certification
(Individuals only)
Do you qualify for Low-Income Certification? You qualify if your gross monthly household income is less than or equal to the amount shown in the chart
below based on your family size and where you live. If you qualify, you are not required to submit the $100 application fee.
Check here if you qualify for Low-Income Certification based on the monthly income guidelines below.
Size of Family Unit
48 Contiguous States and D.C.
Hawaii
Alaska
1
$2,256
$2,596
$2,819
2
$3,035
$3,492
$3,794
3
$3,815
$4,388
$4,769
4
$4,594
$5,283
$5,744
5
$5,373
$6,179
$6,719
6
$6,152
$7,075
$7,694
7
$6,931
$7,971
$8,669
8
$7,710
$8,867
$9,644
For each additional person, add
$779
$896
$975
Section 5
Payment Terms
Enter the amount of your offer: $ ____________________________
Check one of the payment options below to indicate how long it will take you to pay your offer in full:
Payment Option 1
Check here if you will pay your offer in within 60 days from written acceptance to the offer.
Amount of down payment, if any, submitted with your offer: $ ____________________________
Payment Option 2
Check here if you will pay your offer in full in more than 60 days and in less than or equal to 60 months and pay in monthly installments.
$
______
is being submitted with the Form OIC-1 and then $ ________________ on the
day of each month thereafter for a total of
___________ months. Total payments must equal the total offer amount.
First payment will be automatically debited from your financial institution on the
day of the month following written acceptance of the offer. Interest
will continue to accrue for all sales tax and withholding tax liabilities. Complete the following:
Financial Institution Name
Financial Institution Mailing Address
Names on the Account
Checking Account
Savings Account
Routing Number
Account Number
OIC-1 (rev. July 2016)
Page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial