Form De 999ca - Multi-Agency Form For Offer In Compromise Page 3

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The following documentation must be submitted with your OIC application or your application may be returned as
incomplete. Please submit copies only. We will not return any documents that you send us. Additional documentation
may be required and requested as the evaluation of the OIC proceeds.
Check List of Required Items (check only those boxes that apply).
Verification of Income
Pay stubs for the past three (3) months or financial statements for the past two (2) years if you are self-
employed.
Verification of Expenses
Billing statements for the last three (3) months (include copies of charge card statements, bills from other
creditors, and personal loan statements).
Bank Information
Bank statements for savings and checking accounts for the last six (6) months. If you are self-employed,
provide bank statements for the last twelve (12) months. If any accounts have been closed within the last two
(2) years, include bank statements for the last six (6) months of each account before the account was closed.
Investment Information
Investment account statements showing the value of stocks, bonds, mutual funds, and/or retirement or profit
sharing plans (IRA, 401(k), Keogh, Annuity).
Current Lease or Rental Agreements
Include all lease agreements, including property where you are the lessor or lessee.
Real Property Information
Mortgage statements and escrow statements for property you currently own, or property you sold or gifted in
the last five (5) years.
IRS/FTB Information
Complete copies of Internal Revenue Service (IRS) or FTB returns for the past three (3) years.
OIC Information
Copies of offers made to other government agencies and acceptance letters or other arrangements made to
resolve your debt.
Legal Documents
Marital settlement agreements, divorce decrees, marital property settlements, trust documents, and
bankruptcy documents.
Medical Documentation
Physician’s letter including diagnosis and prognosis and/or other documents to show any medical condition
that should be considered.
Power Of Attorney
If a designated representative submits this offer, attach the appropriate power of attorney (POA) form
(BOE-392).
Submit your completed and signed application to BOE, FTB, or EDD at the addresses below. The OIC application must
be sent to each separate agency for processing. You should receive an acknowledgement letter from the receiving
agency within 12 working days from the date that your OIC application was received. Please contact us at our telephone
number or website.
Board of Equalization
Franchise Tax Board
Employment Development Department
PO Box 942879
Offer In Compromise Group A453
PO Box 826203, MIC 92S
Sacramento, CA 94279-0052
PO Box 2952
Sacramento, CA 94230-6203
Sacramento, CA 95812-2952
Information Center: (800) 400-7115
Telephone: (916) 845-4787
Telephone: (916) 464-2739
Internet:
Internet:
Internet:
DE 999CA (6-06) (INTERNET)
Page 3 of 12
CU

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Parent category: Financial