Oregon Application For Settlement Offer Page 13
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Section 6. Settlement offer calculations
82. Net disposable income from line 81 (can’t be less than -0-)
83. Disposable income formula (line 82 x 36.0)
84. Total value of all immediate assets and real property equity from line 26 (can’t be less than -0-)
85. Assets and equity formula (line 84 x 0.75)
86. Total settlement offer amount (add lines 83 and 85) .................................................................................
$
87. 5-percent nonrefundable payment submitted with this application (line 86 x 0.05)
$
Payoff information
When will you pay the remainder of this settlement offer? (check one)
Within 10 days from the date of Department of Revenue’s acceptance letter.
In six equal monthly installments. Day of month you want your installment payments due: _____________________________
Will you borrow the settlement offer amount (line 86)?
Yes
No
If yes, provide lender’s name, address, phone; list all collateral, if any, pledged to secure the loan.
Lender information
Collateral
Name
Mailing address
City
State
ZIP Code
Phone number
(
)
Is lender a member of your household or immediate family?
Yes
No
Tax debts included in settlement offer. Check all that apply.
Social Security number or
Tax type
Years/quarters
business identification number
Personal income tax
Business tax
Other (explain)_________________________________________________
Section 7. Additional information. Please include any information you want us to know regarding your settlement offer.
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