Form De 999ca - Multi-Agency Form For Offer In Compromise Page 11

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SECTION 9. OFFER AMOUNT
Part II. Offer to the Franchise Tax Board
(offers will be evaluated independently by each agency)
Amount owed to the
Tax Year(s):
$
Franchise Tax Board:
Account Number(s)
The sum of $
is offered in compromise. (The Franchise Tax Board will instruct you when to
mail the offer amount. DO NOT SEND MONEY NOW.) It is understood that this offer will be considered and acted upon
in due course. It does not relieve the taxpayer(s) of the liability sought to be compromised until the offer is accepted by
the Franchise Tax Board and there has been full compliance with all agreements.
Except for any amount deposited in connection with this offer, it is agreed that the Franchise Tax Board will retain all
payments and credits made to the account for the periods covered by this offer. In addition, the Franchise Tax Board will
retain any and all amounts to which the taxpayer(s) may be entitled under the California law, due through overpayments
of tax, penalty or interest, subsequent to the offer being accepted, not to exceed the liability.
It is further agreed that upon notice to the taxpayer(s) of the acceptance of the offer, the taxpayer(s) shall have no right to
contest in court or otherwise the amount of the liability sought to be compromised. No liability will be compromised until
all obligations of each taxpayer under the compromise agreement are completely performed. In the event of a default by
the taxpayer(s) on the collateral agreement, it is agreed that the Franchise Tax Board may disregard the amount of the
offer and retain all amounts previously deposited under the offer and proceed to collect the balance of the original liability.
I also authorize the disclosure of confidential information to the Board of Equalization and the Employment Development
Department records in relation to the Franchise Tax Board’s Offer in Compromise.
Under penalty of perjury, I declare that I have examined the information given in this statement and all other documents
included with this offer and to the best of my knowledge and belief, they are true, correct, and complete.
Your signature
Date
Signature of Spouse or RDP
Date
If your offer is denied, the agency denying the offer is to:
FTB
Retain any amount deposited to fund the offer and credit the deposit to the current tax liability.
Return the amount deposited.
Source of Funds
If any or all of the amount being offered is from a loan, please provide the following information:
Lender’s Name
Total amount of the loan
$
If any or all of the amount being offered is from a gift, please provide the following information:
Gift donor’s name
Relationship to Taxpayer(s)
Total amount of the gift
$
Describe sources of offered funds other than a loan or a gift
DE 999CA (6-06) (INTERNET)
Page 11 of 12
CU

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