Form Mo-656 - Missouri Department Of Revenue (Page 6 of 6) in pdf

Form Mo-656 - Missouri Department Of Revenue Page 6

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Offer in Compromise Checklist

FOR ALL OFFERS:

Form MO-656 Offer in Compromise (enclosed)

Third Party Affirmation – Power of Attorney Form 2827 (If Applicable)

Supporting Documentation

FOR OFFERS OF DOUBT AS TO COLLECTIBILITY AND ECONOMIC HARDSHIP:

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

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

MO-656 (5-2012)

Form Mo-656 - Missouri Department Of Revenue Page 6