Settlement Offer Application Form - Oregon Department Of Revenue Page 9
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Section 3. General financial information—personal and business (continued)
Safe deposit box contents. Include locations, box numbers, and contents. Attach additional pages as needed.
Name of institution
Address
Box number
Description, current value of contents
$
Total value of all safe deposit box contents. Enter this amount on line 7, Section 4 ...............
Real property. For each property, include copies of deed, homeowner’s/renter’s insurance policy with riders, supporting documentation of loan balance,
and most recent property tax statement. Attach additional pages as needed.
Property 1: Physical address, description (single family home, multi-family home, bare lot, etc.)
Mortgage lender’s name and address
County
Parcel number:_______________
Name(s) of owner(s) on deed:_____________________________________ Purchase price: ______________ Purchase date: ____________
Property 2: Physical address, description (single family home, multi-family home, bare lot, etc.)
Mortgage lender’s name and address
County
Parcel number:_______________
Name(s) of owner(s) on deed:_____________________________________ Purchase price: ______________ Purchase date: ____________
Property 3: Physical address, description (single family home, multi-family home, bare lot, etc.)
Mortgage lender’s name and address
County
Parcel number:_______________
Name(s) of owner(s) on deed:_____________________________________ Purchase price: ______________ Purchase date: ____________
Credit cards and unsecured lines of credit. These are not allowable expenses.
Type of account
Name and address of creditor
Monthly payment
Credit limit
Credit available
Balance
$
Total unsecured credit balance amount. Enter this amount on line 27, Section 4 ......................................
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