Form Oic-1 - Offer In Compromise Application

OIC-1 (Rev 07/05)

Page 3

10. TERMS AND CONDITIONS

By submitting this offer and signing below, I/we understand and agree to the Department’s Offer in Compromise

TERMS AND CONDITIONS as follows:

I/we voluntarily submit any payment made with this offer and understand that it will be applied as a partial payment

toward my/our tax liability and will not be returned, regardless of the disposition of the offer.

I/we will remain in compliance with all tax return filing provisions of the Georgia Public Revenue Code while this

offer is pending. I/we will comply with these provisions for a period of ten (10) years from the date of notification

of acceptance of this offer.

The offer becomes officially acknowledged once written notification of receipt has been made by an authorized

Department official. The offer remains pending until an authorized Department official issues notification of

acceptance or rejection, or until the offer is withdrawn by me/us.

I/we understand that collection enforcement activity will not be suspended while an offer is pending.

The Department will retain and apply any payment toward the liability for which this offer is made, if such payment

was received prior to official acknowledgment of the offer. The Department will retain and apply all credits due to

refund offset when such credits are received prior to the full payment of an accepted offer.

I/we understand that the application fee is nonrefundable and will be credited to the tax debt only if the offer is

accepted. The application fee will not be credited to the tax debt if the offer is declined.

I/we understand that the tax I/we owe is, and will remain, a tax liability until I/we meet all the terms and conditions

of this offer. If I/we file bankruptcy before the terms and conditions of this offer are completed, any claim the

Department files in a bankruptcy proceeding will be a tax claim.

I/we understand that the Department will only consider one offer application in a ten year period.

I/we authorize the Department to obtain bank and financial information, as well as credit history from any

consumer reporting agency, for the purpose of verifying the financial information provided by the OIC applicant.

If I/we fail to meet the terms and conditions of an accepted offer, the offer will be considered null and void. The

Department will continue to add applicable interest and penalty on the total unpaid balance until paid in full. In

addition, the Department may:

Immediately issue and record any tax fi.fa. 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/WE HAVE EXAMINED THIS OFFER, INCLUDING ACCOMPANYING SCHEDULES AND STATEMENTS, AND HEREBY

AFFIRM THAT TO THE BEST OF MY/OUR KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE.

APPLICANT’S SIGNATURE

DATE

APPLICANT’S SIGNATURE

DATE

POWER OF ATTORNEY SIGNATURE

DATE

NOTE:

Departmental Forms CD LO-14B (Statement of Financial Condition for Individuals) and/or CD LO-14C

(Statement of Financial Condition for Businesses) must be completed, signed and attached in order for this to be a

complete offer. Department personnel may request verification of the financial information provided on these forms

and may request additional information.

Form Oic-1 - Offer In Compromise Application - 2005 Page 3