Oregon Application For Settlement Offer Page 6
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16Settlement offer application check list
You must include the following information with your application. If you don’t, we may return it without pro-
cessing, or ask you for more documentation.
Verification of all expenses
All tax debt you owe.
You must verify your household expenses. We accept:
You (and your spouse/RDP, if applying jointly)
must sign the taxpayer agreement and authoriza-
Copies of cancelled checks (front and back).
tion to use credit reports (page 14); and, if needed,
Documents showing payments on court-ordered
the Tax Information Authorization and Power of Attor-
debts.
ney for Representation form (page 15).
Billing statements showing payments.
A nonrefundable payment that is 5 percent of the
Receipts of payments.
settlement offer amount, and payment coupon
(below). Payment must be money order, cashier’s
Self-employed or business owners
check, or cash.
If you’re self-employed or a business owner, you must
include:
Verification of all income sources
A profit/loss statement from your business show-
To verify your household income, you must include:
ing all activity for the current year.
Complete bank statements for the last three months
Bank statements for the last six months for all busi-
for all checking and savings accounts.
ness checking and savings accounts.
Pay stubs for at least the last three months.
A general ledger showing business expenses actu-
ally paid for the current year.
Documentation of other income sources for the last
three months. For example, Social Security, disabil-
Statements for loans you claimed as business
ity, child support, alimony, commissions, etc.
expenses.
We will continue collection action on your tax debt until your settlement offer is accepted.
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✂
FOR OFFICE USE ONLY
SETTLEMENT OFFER PAYMENT COUPON
Date received
Payment must equal 5 percent of your settlement offer.
Include your BIN or SSN, but not both.
Program code
Year
Period
Liability
Business identification number
First four letters of
your last name
Payment amount
Social Security number
$
.
0 0
Last name
First name and initial
Spouse/RDP last name, if different (if applying jointly)
Spouse/RDP first name and initial (if applying jointly)
Current mailing address
State
ZIP code
Phone number
(
)
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