Offer In Compromise Application - Tennessee Department Of Revenue Page 17
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25Page 17
CS-14B
44. Extraordinary Expenses
If the standards in Item 43 are inadequate to provide for basic living expenses, the Department may allow for a larger
Reported Amount to be included in Item 43. Applicants must explain the need below and provide supporting documentation.
Expense
Explanation of Need
Referenced
45. Net Monthly Household Disposable Income:
$
("Monthly Household Disposable Income" Minus "Total Claimed Monthly Living Expenses")
I/we have examined this Statement of Financial Condition for Individuals and hereby affirm that to the best of my/our knowledge and belief, it is true,
correct and complete.
Applicant's Signature
Date
Applicant's Signature
Date
Power of Attorney
Date
Signature
(Attach Power of Attorney - Use Department of Revenue Form RV-F0103801)
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