Form De 999ca - Multi-Agency Form For Offer In Compromise Page 9

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SECTION 7. THREE YEAR INCOME SUMMARY
Prior Year
Prior Year
Current Year
Agency Use
Gross Income Source
To Date
(
)
(
)
Only
Wages / Salaries (Taxpayer)
Pension (Taxpayer)
Overtime / Bonuses / Commissions (Taxpayer)
Wages / Salaries (Spouse or RDP)
Pension (Spouse or RDP)
Overtime / Bonuses / Commissions (Spouse or RDP)
Business income
Rental income
Interest / Dividends / Royalties
Payments from Trusts / Partnerships / Entities
Child Support
Alimony
Unemployment
Disability
Social Security
Other income (describe)
Other income (describe)
Other income (describe)
Other income (describe)
Totals >>
SECTION 8. Please explain why your offer should be accepted.
(Attach additional pages as needed.)
The following facts and reasons are submitted as grounds for acceptance of this offer.
DE 999CA (6-06) (INTERNET)
Page 9 of 12
CU

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Parent category: Financial