Form Boe-490-C - Offer In Compromise Application Page 4

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BOE-490-C REV. 1 (11-08)
Offer IN COmPrOmISe APPLICAtION
SeCtION 1. BASIS fOr tHe Offer
The following facts and reasons are submitted as grounds for acceptance of this offer
SeCtION 2. SOurCe Of fuNdS
If any or all of the amount being offered is from a loan, please provide the following:
LENDER’S NAME
TELEPHONE NUMBER
TOTAL AMOUNT OF THE LOAN
(
)
$
LENDER’S ADDRESS (city, state, zip code)
TOTAL AMOUNT FROM OTHER SOURCES
$
DESCRIBE SOURCES OF OFFERED FUNDS OTHER THAN A LOAN
IF THIS OIC IS DENIED, THE BOE IS TO:
Retain OIC deposit and credit it to the current tax liability
Return the amount deposited
OFFER IN COMPROMISE APPLICATION
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Parent category: Financial