Form De 999c - How To Prepare The Offer In Compromise Financial Statement (De 999b) - State Of California
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1HOW TO PREPARE THE OFFER IN COMPROMISE FINANCIAL STATEMENT (DE 999B)
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our request for an Offer in Compromise cannot be processed if the DE 999B is incomplete or unsigned. The DE 999B
must be signed and dated by the applicant. Complete all blocks, except shaded areas. The DE 999B must include
complete information for you and your spouse or your corporation. All of your spouse’s assets and income are
applicable. If you are self‑employed or currently involved in an active business as a partner or corporate officer,
you must enclose a current profit and loss statement with the DE 999B. You must submit copies of your personal
federal tax returns for the last two years. If you and your spouse filed separate returns, both returns must be
submitted. Full financial disclosure is required and supporting documents must be attached to your DE 999B. Upon
receipt of your offer, additional information may be requested for processing.
Note: If you are filing on behalf of a corporation, the DE 999B should be completed with the corporation’s information
and not the individual’s information.
CURRENT ASSETS
Income — Enter gross amount of wages/salary
Bank Account — Enter all accounts even if there is
(attach pay stubs for the last six months). If you are
currently no balance. DO NOT enter bank loans.
self‑employed, enter your net business income (what
You MUST enclose copies of bank statements for
you earn after you have paid your ordinary, necessary
all accounts for the last six months (if you have
monthly business expenses) and attach a current
seasonal sporadic employment, you must enclose
profit/loss statement and balance sheet. List net
copies of bank statements for all accounts for the last
rental income and identify sources of other income.
12 months.)
Necessary Living Expenses — Enter mandatory payroll
Accounts/Notes Receivable — Enter requested
deductions (regular withholding for state and federal
information. Also attach a separate list describing
taxes and Social Security). Do not include insurance
when the receivable is due and how frequent (i.e.,
payments, loan payments, or wage garnishments,
regular customer or one‑time customer.)
etc. Attach an itemized list for medical, insurance,
Available Credit Sources — List only credit lines or
vehicle, and other expenses. Submit documentation
cards by a bank, credit union, or savings and loan
that court‑ordered payments and child/spousal
institution that have cash advance features. Attach all
support payments have been paid for the last
revolving credit card statements.
six months and are currently being paid. Submit
PERSONAL ASSETS
documentation of all wage garnishments, payment
Enter all vehicles, boats, RVs, motorcycles, campers,
plans, estimated tax payments, and settlement offers
etc. Attach a list detailing where the assets are
with the Internal Revenue Service, other tax agencies,
located, the registered owners and lien holders, and
and general creditors. Submit lien information on
expected payoff dates.
these liabilities. This information may be obtained
from a credit report or through the County Recorder
REAL PROPERTY ASSETS
Office in which the property is located.
List all real estate that you own or are purchasing,
EMPLOYMENT INFORMATION
both as an individual or with others. Attach a list
of all owners’ names and type of ownership (joint
Include the business name and address.
tenants, tenants in common), describe type of
OTHER INFORMATION
buildings on the property, mortgage payments,
Mark appropriate box. For all “yes” answers, enter full
rental income amounts, and what the property is
explanation in space provided.
used for (residence, office/shop, rental). Submit lien
information on all properties and current mortgage
HEALTH/MEDICAL CONSIDERATIONS
statement(s).
Describe in the space provided any health, disability,
or medical considerations that do or will effect
MONTHLY INCOME AND EXPENSES
current or future financial status or earning potential
List total household income and expenses for both
for either you or your spouse. Submit supporting
you and your spouse, even if only one spouse has a
documentation.
tax liability.
For further information or assistance, please contact the Offer in Compromise Unit at 916-464-2739.
The EDD is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.
DE 999C Rev. 1 (11‑14) (INTERNET)
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