Form 656 Booklet - Offer In Compromise Page 19
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28Page 5 of 6
Section 5
Calculate Your Minimum Offer Amount
The next steps calculate your minimum offer amount. The amount of time you take to pay your offer in full will affect your minimum offer amount.
Paying over a shorter period of time will result in a smaller minimum offer amount.
If you will pay your offer in 5 months or less (Payment Option 1), multiply "Remaining Monthly Income" (Box 4) by 48 to get "Future Remaining Income."
Enter the amount from Box 4 here
Box 5 Future Remaining Income
X 48 =
$
$
If you will pay your offer in more than 5 months (Payment Option 2), multiply "Remaining Monthly Income" (from Box 4) by 60 to get "Future Remaining
Income."
Enter the amount from Box 4 here
Box 6 Future Remaining Income
X 60 =
$
$
Determine your minimum offer amount by adding the total available assets from Box 1 to amount in either Box 5 or Box 6.
Minimum Offer Amount
Enter the amount from Box 1 here*
Enter the amount from either Box 5 or Box 6
+
=
Must be more than zero
$
$
$
If you have special circumstances that would hinder you from paying this amount, explain them on Form 656, Offer in Compromise, Page 2,
"Explanation of Circumstances."
*You may exclude any equity in income producing assets shown in Section 2 of this form.
Section 6
Other Information
Additional information IRS needs to
Is the business currently in bankruptcy?
consider settlement of your tax debt. If this
Yes
No
business is currently in a bankruptcy
Has the business ever filed bankruptcy?
proceeding, the business is not eligible to
apply for an offer.
Yes
No
If yes, provide:
Date Filed
Date Dismissed or Discharged
(mm/dd/yyyy)
(mm/dd/yyyy)
Petition No.
Location
Does this business have other business affiliations
?
(e.g., subsidiary or parent companies)
Yes
No
If yes, list the Name and Employer Identification Number:
Do any related parties (e.g., partners, officers, employees) owe money to the business?
Yes
No
Has the business been party to a lawsuit?
Yes
No If yes, date the lawsuit was resolved:
In the past 10 years, has the business transferred any assets for less than their full value?
Yes
No
Has the business been located outside the U.S. for 6 months or longer in the past 10 years?
Yes
No
Does the business have any funds being held in trust by a third party?
Yes
No If yes, how much $
Where:
Does the business have any lines of credit?
Yes
No If yes, credit limit $
Amount owed $
What property secures the line of credit?
Section 7
Signatures
Under penalties of perjury, I declare that I have examined this offer, including accompanying documents, and to the best of my knowledge it
is true, correct, and complete.
Signature of Taxpayer
Title
Date
(mm/dd/yyyy)
433-B (OIC)
Catalog Number 55897B
Form
(3-2011)
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