Form R-20211 - Document Checklist For Offer To Compromise Based On Serious Doubt As To Collectibility


R-20211 (11/98)
State of Louisiana
Department of Revenue
Document Checklist for Offer to Compromise
Based on Serious Doubt as to Collectibility
Consideration for an Offer in Compromise based on serious doubt as to collectibility will require an in-depth
financial analysis. To expedite this process, it is necessary that the following information and documents be
provided along with the initial application.
Copies of federal income tax returns for the two most current years.
Copies of bank statements for all checking and savings accounts, personal and/or business, for the
most current six months.
Copies of current statements showing the value of all retirement accounts, pensions, and profit-sharing
plans for the most current six months.
A list of all stocks, bonds, and/or other securities owned, along with the current market value of each.
A statement from the insurance company for each life insurance policy showing the current cash loan
value, accumulated dividends and interest, dates and amounts of policy loans, and the amounts of
A list of all real estate owned, wholly or in part, with appraisals, if available, and a statement of payoff on
each mortgage.
A statement from lending institutions and other creditors that clearly indicates current balances owed
and payment schedule on all notes payable and/or revolving accounts.
A complete inventory of asset-bearing items contained in all safe deposit boxes, including fair market
value of each item, copies of documents, etc.
Copies of any judgments or legal decrees, excluding bankruptcy, for the past six years.
A list of all business equipment, office furniture, and other business assets, including the current fair
market value of each.
A list of all accounts receivable (business), showing the payor, amount due, age, and status of each
If personal liability applies, then proof of employment, income, commissions, fees, pensions, etc., must
be provided for both applicant and spouse. Even though the spouse may not be liable, this is needed
for equitable distribution of cost-of-living expenses.
Denials of loan requests by two or more financial institutions.
I have completed each checkoff item from the above document list. I have checked each item that is appli-
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