Form Boe-490 - Offer In Compromise Application Page 3
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11BOE-490 (S1F) REV. 1 (1-06)
STATE OF CALIFORNIA
OFFER IN COMPROMISE APPLICATION
BOARD OF EQUALIZATION
The following documentation must be submitted with your Offer in Compromise Application or your application may
be returned as incomplete. Please submit copies only. We will not return any documents that you send us.
Additional documentation may be required and requested as the evaluation of the Offer in Compromise proceeds.
Check List of Required Items (Check only those boxes that apply.)
Please read the required Privacy Notice (BOE-324-OIC).
Verification of Income
Pay stubs for the past three months or financial statements for the past two years if you are self-
employed (Please include total household income.)
Verification of Expenses
Billing statements for the last three months (Please include copies of charge card statements, bills
from other creditors and personal loan statements.)
Bank Information
Bank statements for savings and checking accounts for the last six months (If you are self-
employed, provide bank statements for the last twelve months. Please include bank statements for
any accounts that have been closed within the last two years.)
Investment Information
Investment account statements showing the value of stocks, bonds, mutual funds and/or retirement
or profit sharing plans (IRA, 401K, Keogh, Annuity)
Current Lease or Rental Agreements
(Please include all lease agreements, including property where you are the lessor or lessee.)
Real Property Information
Mortgage statements and escrow statements for property you currently own, or property you sold or
gifted in the last five years (Please include quit claim deed transfers and property held in trust. If a
trust exists, please provide a copy of all trust documents.)
IRS/FTB Information
Complete copies of Internal Revenue Service (IRS) or Franchise Tax Board (FTB) returns for the
past three years
(If applicable, please include a copy of IRS, FTB, or EDD OIC and acceptance letter or other
IRS/FTB/EDD arrangements.)
Legal Documents
Marital settlement agreements, divorce decrees, marital property settlements, trust documents, and
bankruptcy documents
Medical Documentation
Physician’s letter and/or other documents to show any medical condition that should be considered
Power of Attorney (If you have representation)
If a designated representative submits this offer, attach the appropriate power of attorney (POA) form.
(BOE-392, Power of Attorney, may be used.)
Submit your completed and signed application to your designated Board compliance representative.
If you have questions, other than those addressed on the last page of this booklet, please contact your
Board compliance representative.
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