Offer in Compromise
Potential Qualification Questionnaire
An Offer in Compromise is a process available to taxpayers with significant tax liabilities that provide an opportunity to “settle” their liabilities for less than the full amount. Basically, you must be in a financial position wherein you would be unable to fully pay your liabilities (including accruing penalties and interest) within the statutory period of collection (roughtly 10 years from return filing for the IRS) through the sale of all your assets and by making monthly payments.
If you are contemplating filing an Offer in Compromise based on Doubt as to Collectability (hereinafter referred to as an “OIC”) and wish me to evaluate your potential eligibility, please complete the form below as accurately as possible. If you see a next to a question, you can click on that symbol to “pop-up” a window for additional information on that question. Then click on the BACK button of that window to return to the questionnaire. The questions on income and expenses refer to average MONTHLY totals.
This is important. If you are paid weekly, multiply the weekly GROSS WAGES and the DEDUCTIONS by 4.3 to get an average per month. The same is true for any expenses paid on a weekly basis. If you are paid or you pay expenses bi-weekly (every two weeks), then multiply those bi-weekly amounts by 2.16 to get a monthly average. Unless you are frequently paid overtime, use your base wages and withholding information.
If you pay an expense (such as auto or property insurance) annually, divide that amount by 12 to arrive at a monthly total. Property taxes are usually paid twice a year. Divide one of the payments by 6 to arrive at a monthly total. Out of pocket medical expenses vary from month to month. Take a sample of no fewer that three (3) months to arrive at a monthly average. The IRS has a “standard” of allowing taxpayers under 65 an an amount of $60 per month. If 65 or older, then the standard is $120 per month. If you feel the standard is appropriate for you (and the members of your household), then you can use the standard for each taxpayers and dependent.
Please answer all questions – otherwise, I will not be able to accurately assess your potential qualification for an OIC. Please – ensure your E-mail address is accurate or I will be unable to contact you. Unfortunately, I have received questionnaires WITHOUT a valid E-mail address! Please – make sure you include this information so I can get back to you. If you submit this form and do not hear back within 24 hours, then something likely is wrong with your contact information! Call me (818-842-5927).
Print out the completed questionnaire and then either fax it to: (818-845-6031), scan/e-mail it to me, or mail it to: Richard E. Norton, EA, Tax Resolution Specialist, 513 North Florence Street, Burbank, CA 91505.
|Your First Name ||Last Name (Optional)||Age|
|Spouse First Name||Spouse Last Name (Optional)||Age|
|City||State / Country ||County (in U.S.) Zip|
|Day Phone||Evening Phone||Cell Phone||Fax Number|
|E-mail address (required for my response to you)|
|Number of dependents who qualify as an exemption on your tax return. Do NOT include you or your spouse.|
|Have you ever filed bankruptcy?||Yes No|
If YES, in what month and year were you discharged?
Are you able to pay an estimated retainer of $1,350 ($1,800 for both IRS and a STATE offer) to start the process?
NOTE: The amount of your retainer depends upon the complexity of your personal finances. The estimates above are the minimum retainer amounts for wage earners and small service-oriented businesses.
End of Questionnaire