Oregon Application For Settlement Offer Page 4
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16Application instructions
• You must complete all sections.
Section 4. Asset and debt analysis
• Don’t fill in shaded boxes.
Lines 2–7, enter totals from Section 3.
• Attach additional pages if necessary.
Lines 17–18, don’t include everyday household items
such as clothing, furniture, appliances, etc.
• Print clearly.
Lines 20–22, include properties listed in Section 3. To
determine current property value, use the real market
Section 1. Personal information
value (RMV) from your most recent property tax state-
Fill out completely and include all members of your
ment.
household.
Line 27, include unsecured credit balance from Section
3 only if you filled it in.
Section 2. Employment information
Lines 30–32, explain other debts and provide support-
There are two sections: one for your employment infor-
ing documentation.
mation and one for your spouse/registered domestic
partner (RDP) employment information.
Section 5. Monthly income and expense analysis
Provide the name of your employer, or the name of
• Important—If you work on commission or own
your business if you’re self-employed.
a business, we may ask you for more than three
Check the “paid” box that applies to how frequently
months pay stubs.
you get a pay check.
Fill in gross and net amounts, except where boxes are
• Important—Include the number of allowances you
shaded.
claim on your most recent W-4 form.
Line 50, explain other income and provide supporting
documentation.
Section 3. General financial information–
Lines 52–68, provide proof of monthly payments for
personal and business
each expense.
Bank accounts—List all bank accounts. For the total dol-
Lines 70–77, provide proof of monthly payments for
lar amount in your accounts, add together only those
each business-related expense.
accounts with positive balances.
• Important—For any bank accounts with negative
Section 6. Settlement offer calculations
balances, enter -0-.
Line 83, disposable income formula.
Example: Bob has three bank accounts:
Example: Anne’s net disposable income from line 81
1. Checking account 1
$400.00
is $1,500. She enters $1,500 on line 82 and multiplies
it by 36.0.
2. Checking account 2
–$100.00
$1,500 x 36.0 = $54,000
3. Savings account
$600.00
She enters $54,000 on line 83.
He lists all three accounts and enters -0- in the Bal-
ance column for checking account 2. The total of his
Line 85, assets and equity formula.
bank accounts is $1,000; not $900.
Example: Anne’s total value of all immediate assets
Personal property—If you own a business, include only
and real property equity from line 26 is $3,000. She
personal property not used in your business.
enters that on line 84 and multiplies it by 0.75.
Credit cards and unsecured lines of credit—We don’t allow
$3,000 x 0.75 = $2,250.
these expenses when we determine your ability to pay.
She enters $2,250 on line 85.
Other financial information—Include any court proceed-
ings that resulted in or may result in a financial judg-
Line 86, add lines 83 and 85 to get your settlement offer
amount.
ment in your favor.
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