Form Rv-F0200401 - Instructions For Completing Form Oic-1 - Offer In Compromise (Page 5 of 5) in pdf

Tennessee Department of Revenue

Offer in Compromise

DOCUMENT CHECKLIST

An offer in compromise submitted under the doubt as to collectability provisions will require an in-

depth analysis of your financial condition. To expedite this process, it is necessary that you provide

the following additional information and documents along with your initial application.

[ ] Copies of federal income tax returns for two most current years.

[ ] Copies of bank statements for all checking and savings accounts, personal and/or business,

for the two most current months (or periods).

[ ] Copies of statements, showing the value of your interest in all retirement accounts, pensions,

and profit sharing plans for the two most current months (or periods).

[ ] A list of all stocks, bonds, and/or 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, dates and amounts of policy, loans, and

the amount of loan.

[ ] Statement of payoff on all mortgages of real estate you own or have interest in.

Also appraisals, if any, on all real estate you own or have an interest in.

[ ] Statement from lending institutions and other creditors that clearly indicates current balances

owed, and payment schedule on all notes payable and or revolving accounts.

[ ] Safe Deposit Boxes; A complete inventory of the content of all safe deposit boxes in which you

have an interest, including fair market value of each item, copies of documents, etc.

[ ] Copies of any judgments or legal decrees, (excluding bankruptcy), for past six years.

[ ] A list of all your business equipment, office furniture, and other business assets, including fair

market value of each item, copies of documents, etc.

[ ] A list of all accounts receivable, (business), showing the payor, amount due, age, and status of

each account.

[ ] If personal liability applies then you must provide proof of employment, income, commissions,

fees, pensions, etc., for yourself and spouse, if applicable. Even though your spouse may not

be liable, this is needed for equitable distribution of cost of living expenses: (In most cases,

copies of the two most current pay stubs)

I have completed each check-off item from the above document list. I have checked each item that

is applicable. Any item not checked has been noted, “NA”.

[ ] Name:

Daytime Phone Number

Signature

Form Rv-F0200401 - Instructions For Completing Form Oic-1 - Offer In Compromise Page 5