Settlement Offer Application Form - Oregon Department Of Revenue Page 5
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16Line 87, 5-percent nonrefundable payment to submit
Section 7. Additional information
with your application (whole dollar amount only).
You may include information that you want us to know
Example: Anne adds her disposable income formula
regarding your settlement offer.
amount of $54,000 (line 83) to her assets and equity
formula amount of $2,250 (line 85).
Terms and conditions
$54,000 + $2,250 = $56,250.
Read the terms and conditions carefully before you
sign the taxpayer agreement.
She enters $56,250 on line 86 and multiplies it by
0.05
Taxpayer agreement and authorization to use
$56,250 x 0.05 = $2,812.50
credit reports
She enters $2,812.50 on line 87.
By signing, you confirm that the information in your
application is correct and complete to the best of your
Anne gets a cashier’s check for $2,813, fills out the
knowledge.
payment coupon (page 6), and includes both with
her application.
Your signature also authorizes us to use credit reports
and other tools to verify any information in your appli-
Payoff information—You must pay the offer amount in
cations, and for collection purposes.
full within 10 days from the date of our acceptance letter.
Before mailing
If you can’t pay it all at once, you may pay it off in six
equal monthly payments. Write the day of the month
Review your application to make sure it’s complete and
you want your installment payment to be due.
includes all supporting documentation, your payment,
and the payment coupon.
Tax debts included in settlement offer—Write the tax type
and years/quarters of taxes.
Have questions? Need help?
Internet
Phone
Settlement offers ......................................... 503-945-8824
• Download forms, instructions, and publications.
Salem area or outside Oregon .................... 503-378-4988
• Check your refund status.
Toll-free from an Oregon prefix ............... 1-800-356-4222
• Make payments.
• Check your refund status.
• Find out how much you owe.
• Order forms, instructions, and publications.
Twitter: ORrevenue
• Listen to recorded information.
• Speak with a representative:
E-mail or write
Monday–Friday ...................................... 7:30 a.m.– 5 p.m.
Closed Thursdays from 9–11 a.m. Closed holidays. Extended
General: questions.dor@state.or.us
hours during tax season; wait times may vary.
Settlement offers: settlement@dor.state.or.us
Asistencia en español:
Oregon Department of Revenue
En Salem o fuera de Oregon ...................... 503-378-4988
955 Center St NE
Gratis de prefi jo de Oregon ..................... 1-800-356-4222
Salem OR 97301-2555
TTY (hearing or speech impaired; machine only):
• Include your name and daytime phone number.
Salem area or outside Oregon ................... 503-945-8617
• Include the last four digits of your SSN or ITIN.
Toll-free from an Oregon prefi x .............. 1-800-886-7204
Printed forms or publications:
Americans with Disabilities Act (ADA): Call one of the help
Forms
numbers above for information in alternative formats.
Oregon Department of Revenue
PO Box 14999
In person
Salem OR 97309-0990
Español: preguntas.dor@state.or.us
Find directions and hours on our website.
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