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Form BOE-490-C Fillable Offer in Compromise Application for Corporations, Limited Liability Companies, Partnerships,Trusts,and unidentified Business Organizations
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)ability to pay All required documentation to support the OIC Completed OIC application concealment of assets or existence of fraud equity in the entity s assets potential for changed circumstances present and future expenses present and future income When the partner is not an individual You are a consumer who accrued use tax You are a successor that inherited the liability You are an active business with a final liability You have fully completed the OIC application You no longer have a controlling interest or (BOE 324 OIC) (BOE 490) from BOE s website or contact your (Column A minus Column B equals Column C) tOtAL eQuItY >> (Santa Rosa field office) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (You are not required to send the offer amount with the application ) * Limited services are available in Eureka See 1 Cash 10 Judgments/settlements receivable (from Section 5) 11 Machinery and equipment (from Section 5) 12 Merchandise inventory (from Section 5) 13 Aircraft watercraft (please list CF number or Hull ID number) 14 Interest in partnerships 15 Interest in trusts 16 Other assets (include description) 17 Other assets 18 Subtotal of assets (current equity and other) >> 19 Lines of credit (amount owed from Section 5) 2 Bank accounts/balance (from Section 5) 20 Notes/accounts payable (include description) 2012 the OIC program will extend to qualified 21 Taxes owed to IRS (provide a copy of recent notices) 22 Taxes owed to FTB (provide a copy of recent notices) 23 Taxes owed to EDD (provide a copy of recent notices) 24 Judgments (provide a copy) 25 Other liabilities (include description) 26 Gross receipts from sales services etc 27 Gross rental income 28 Interest 29 Dividends 3 Vehicles/available equity (from Section 5) 30 Royalties 31 Other income (include description) 32 Other income 33 Other Income 34 Other Income 35 Other Income 36 Other Income 37 Other Income 38 Compensation of officers (attach detailed list) 39 Net wages and salaries (including stock options 4 Loan (from Section 5) 40 Materials purchased 41 Rents 42 Installment payments 43 Supplies 44 Utilities/telephone 45 Gasoline/oil 46 Repairs and maintenance 47 Insurance 48 Taxes 49 Other expenses (include description) 5 Securities (from Section 5) 50 Other expenses 51 Other expenses 52 Other expenses 53 Other expenses 54 Other expenses 800 400 7115 9 Notes/accounts receivable (from Section 5) a balance sheet and any other related documents a completed application and documentation A Generally an offer will be accepted when the A Generally if we accept your offer for processing A Many BOE forms and publications including A No Prior payments are not accepted towards A No Representation is not required An OIC is A No Your BOE offer will be evaluated separately A power of attorney is required if a designated A qualified active business is an active business A Yes Beginning January 1 2009 both qualified A Yes If you choose to do so the effective date A Yes In most cases we will contact you to A Yes We release state tax liens upon final acceptable will I be contacted? accepted not to exceed the liability accepted? account Accounts and notes receivable (loans to shareholders officers partners members etc ) active businesses and closed out businesses active businesses where the taxpayer or feepayer activity jeopardizes our ability to collect the ADDRESS ADDRESS (city state zip code) ADDRESS (city state zip code) ADDRESS OR LOCATION Agreement You will receive a written response all obligations of each taxpayer or feepayer under the compromise agreement are completely performed Although each case is evaluated based on its own amount in a lump sum payment If you choose amount is not paid within 12 months your offer amount of the offer is paid in full within twelve amount offered is more than the BOE can AMOUNT OWED TO THE BOE amount you owe we may continue with collection amount? an individual and another entity (corporation LLC and a statement of balance with the acceptance letter and acceptance letter or documentation of other and fees owed to the State to successors of businesses and Franchise Tax Board (FTB) returns for the and provide a decision within 180 days of receiving and provided all supporting documentation and the corporation application should be and the offered amount compared to the total ANTICIPATED INCREASE IN INCOME approval and funding of your offer If another ARE FORECLOSURE PROCEEDINGS PENDING ON ANY REAL ESTATE THAT THE ENTITY OWNS OR HAS AN INTEREST IN? (If yes please give the location of the real estate ) Are you an OIC candidate? association with the business that incurred the Attorney AUTHORIZED REPRESENTATIVE S ADDRESS (attach power of attorney) available to all tax or fee payers whether or Bakersfield 661 395 2880 Centralized Collections 916 445 3670 Bank Accounts (payroll general savings certificates of deposit etc ) List accounts held during the past 3 years Bank credit available (lines of credit etc ) Bank Information Bank statements for all savings checking and BANKRUPTCIES/RECEIVERSHIPS (If yes please include chapter case number and date filed ) be denied and all funds received through the offer will be retained BENEFICIARY TO TRUST ESTATE ETC Board of Equalization BOE 392 can be downloaded from our website BOe 392? BOE 490 C REV 1 (11 08) BOE 490 C REV 1 (11 08) Corporate Application BOE will generally give more favorable consideration bonuses loan payments and cash pay outs) BUSINESS SOLD (If yes please provide a copy of the sales contract ) CALIFORNIA BUSINESS NUMBER can make monthly installment payments cash flow statements profit and loss statements checked please provide dates explanation and documentation Documentation should cover the last three years Chicago IL 312 201 5300 Chula Vista 619 409 7440 Timber Tax Section 916 445 6964 City Area Phone Out of State Accounts Property and Special closed out account Code Number taxes department Complete copies of Internal Revenue Service (IRS) concerning your offer contact your local district office For more specific Copies of judgments pending lawsuits trust Copies of loan/lease statements for all vehicles CORPORATE OFFICER/DIRECTOR/SHAREHOLDER S NAME AND ADDRESS Corporations Culver City 310 342 1000 Private Railroad Car Tax 916 327 2739 CURRENT Current assets Current Lease or rental Agreements Current liabilities (attach additional pages as needed) CURRENT MARKET VALUE currently owned sold or gifted in the last five DATE INCORPORATED days after receiving your offer If your account DENOMINATION CURRENT VALUE deposit to your liability Credit interest will not be deposited amount staff must get written permission from the third party to apply the deposit The case will be returned to the DESCRIBE SOURCES OF OFFERED FUNDS OTHER THAN A LOAN DESCRIPTION (manufacturer model number etc ) NAME AND ADDRESS OF LIEN/NOTE HOLDER BALANCE DUE DESCRIPTION COST BALANCE DUE discuss your account and to determine the DIVIDEND DISTRIBUTIONS (If yes please list dates and amounts of 3 most recent distributions ) documents and bankruptcy documents effective date of the date the funds were received No interest will be granted on returned deposits If a third party has posted the Effective January 1 2009 through December 31 efforts El Centro 760 352 3431 Fuel Taxes Division 916 322 9669 Employment Development Department (EDD) OIC ENTITY OFFICIALLY DISSOLVED (If yes please include details on disbursements of entity s assets List all disbursements during the last 6 months on a separate page ) EQUITY Eureka* 707 576 2100 Excise Taxes Division 916 327 4208 evaluating your offer Except for any amount deposited in connection with this offer it is agreed that the BOE will retain all payments and credits made to expect to collect within a reasonable period of expenses FAIR MARKET Fax 916 323 3319 FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) filled out respectively following: For example if we determine that you have form of a non interest bearing deposit If your OIC Fresno 559 248 4219 Environmental Fees Division 916 323 9555 From TDD/TTY 800 735 2929 from your IRS FTB or EDD offer full where the Board of Equalization (BOE) finds funds future the income assets or means to Generally an offer will not be forwarded for approval until the offer is funded Once the offer is approved and funded the OIC Section Generally we approve an OIC when the amount has not received tax or fee reimbursement for tax have in the foreseeable future the income assets Houston TX 281 531 3450 HOW IS TITLE HELD? HOW IS TITLE HELD? If any or all of the amount being offered is from a loan please provide the following: If the entity is subject to annual audit IF THIS OIC IS DENIED THE BOE IS TO: If we reject or deny the offer the deposit will be refunded or applied to the liability at the request of the tax or fee payer with an If you are making an offer as a corporation In most cases no new collection action will be in the evaluation: Include all lease agreements including property Income (continued) Income (Please furnish the information requested below from income tax returns as adjusted for the past three years ) individual or an individual of a partnership you information on the OIC process you may contact investment accounts held within the last twelve IRS/FTB/EDD arrangements IrS/ftB/edd Information Irvine 949 440 3473 is denied and subsequently refunded is denied the full amount of your deposit will be is more complex it may take longer than 180 It is further agreed that upon notice to the taxpayer or feepayer of the acceptance of the offer the taxpayer or feepayer shall have It is understood that this offer will be considered and acted upon as quickly as possible It does not relieve the taxpayer or feepayer Judgments last three years filed Please include all attached Legal documents LENDER S ADDRESS (city state zip code) LENDER S NAME liability are taken into consideration when liability or a related business Limited Liability Companies LIQUIDATION List any vehicles equipment or property sold given away or repossessed during the past three years List of entity officers general partners managing members LISt Of reQuIred ItemS LLC trust organization or a limited or general local district office If you are making an offer as local district office or headquarters office with a recommendation for case handling based on information analyzed during the offer machinery and equipment MARKET VALUE MARKET VALUE CURRENT PAYOFF AVAILABLE EQUITY may be entitled under the California law due through overpayments of tax or fees penalty or interest prior to the offer being merchandise inventory merit we give the following factors strong consideration months Final statement for any accounts closed months Or you may choose to pay the offered MORTGAGE LENDER S NAME MORTGAGE LENDER S NAME MORTGAGE PAYOFF VALUE Mortgage statements escrow settlement statements most appropriate resolution of your account my offer is being evaluated? NAME ADDRESS STATUS DATE DUE AMOUNT DUE NAME CASE NUMBER DATE RECORDED NAME OF BUSINESS ENTITY NAME OF INSTITUTION ADDRESS CREDIT LIMIT CREDIT AVAILABLE AMOUNT OWED MO PAYMENT NAME OF INSTITUTION ADDRESS TYPE DATE OPENED ACCOUNT NUMBER BALANCE NAME OF OWNER(S) BUSINESS ADDRESS TELEPHONE NUMBER TITLE ner s liability will not be cancelled nor will the Net difference (total income less expenses) >> New York NY 212 697 4680 no evidence that the taxpayer collected sales or no right to contest in court or otherwise the amount of the liability sought to be compromised No liability will be compromised until Norwalk 562 466 1694 not receive tax or fee reimbursement not they are represented If you think you need Oakland 510 622 4100 of at least the tax or fee portion of the liability of the liability sought to be compromised until the BOE accepts the offer and there has been full compliance with all agreements of the payment is the date the deposit was of your predecessor Offer In Compromise Application OFFER IN COMPROMISE APPLICATION offer? offered represents the most we can expect OIC proceeds Your OIC must include the only We will not return any documentation that or become final after the date of the compromise are not covered or copies of grant deeds for any property or feepayers that do not have and will not or means to pay their liability in full It allows a or our customer service representatives at Other assets Value other partner s lien be released Other related businesses List any of the business parent or subsidiary corporation relationships Out of State field Offices paid to you on the deposited amount if your offer PARCEL NUMBER PARCEL NUMBER partner existed on the permit the other part partnership please use this application For an Partnerships pay their non disputed board assessed liability in PAYABLE OR Payment Agreement while your offer is being considered payment of a non disputed final tax liability on a payments as established in your Installment PENDING LITIGATION OR JUDGMENTS (If yes please provide case number and court location ) PERIOD(S) OF LIABILITY Phone 916 324 2798 PHYSICAL ADDRESS AND DESCRIPTION (single family dwelling multi family dwelling lot etc ) PHYSICAL ADDRESS AND DESCRIPTION (single family dwelling multi family dwelling lot etc ) Please note that the OIC covers only the final liabilities requested in the OIC application Any future liabilities that may be assessed Please note: If you choose to make installment payments and the offered amount is not paid within twelve months your offer will Please provide additional information relating to the financial conditionof the corporation LLC pertnership or trust If yes is Please read the required Privacy Notice please submit audited financial statements Please submit your completed and signed application Power of Attorney predecessors and to consumers who incurred a previously received a compromise process PrOCeSSING ACCePted OfferS PrOCeSSING deNIed OfferS PURCHASE DATE PURCHASE DATE PURCHASE PRICE PURCHASE PRICE Q Can I make payments on the offered Q Can prior payments be applied to the offered Q do I need to have someone represent me? Q How long will it take to get a decision on my Q If my offer is rejected can I choose to apply Q If the BOe determines that my offer is not Q my IrS/ftB/edd OIC has been accepted Q What does the BOe consider a fair offer in Q Where can I get a Power of Attorney Q Will state tax liens be released if my offer is QUANTITY OF Rancho Mirage 760 770 4828 real property (from Section 5) reAL PrOPertY (include a copy of the deed) real Property Information RECEIVABLE? AMOUNT RECENT TRANSFER OF ASSETS (If yes please include details on disbursements of entity s assets ) RECORDED Redding 530 224 4729 refunded to you or you may choose to apply the relation to the amount due? REPOSSESSIONS representation there are many tax professionals representative assigned to your account please representative submits this offer or if you want required and requested as the evaluation of the Retain OIC deposit and credit it to the current tax liability Return the amount deposited Riverside 951 680 6400 Sacramento 916 227 6700 Sacramento CA 916 227 6600 Salinas 831 443 3003 You can call our toll free Taxpayer Information San Diego 619 525 4526 Section for answers to your general tax questions San Francisco 415 356 6600 Representatives are available to assist you Mon San Jose 408 277 1231 day through Friday 8:00 a m 5:00 p m Pacific San Marcos 760 510 5850 Santa Rosa 707 576 2100 Toll free number 800 400 7115 schedules If applicable copy of IRS FTB or SeCtION 1 BASIS fOr tHe Offer SeCtION 2 SOurCe Of fuNdS SeCtION 3 Offer AmOuNt SeCtION 4 BuSINeSS eNtItY INfOrmAtION (attach additional pages as needed) SeCtION 5 GeNerAL fINANCIAL INfOrmAtION (attach additional pages as needed) SeCtION 5 GeNerAL fINANCIAL INfOrmAtION (Continued) SeCtION 6 ASSet ANd LIABILItY ANALYSIS SeCtION 6 ASSet ANd LIABILItY ANALYSIS (Continued) SeCtION 7 mONtHLY INCOme ANd eXPeNSe ANALYSIS SeCtION 7 mONtHLY INCOme ANd eXPeNSe ANALYSIS (Continued) Securities (stocks stock options bonds mutual funds money market funds other securities etc ) SELLER S PERMIT OR BOE ACCOUNT NUMBER(S) should be submitted The funds will be held in the Should I continue to make installment payments should request the OIC package for individuals showing the value of stocks bonds and mutual SIGNATURE SIGNATURE TITLE STATE OF CALIFORNIA STATUS submit your offer to the representative assigned to submitting an offer does not automatically Suisun City 707 428 2041 suspend collection activity If delaying collection taken while your offer is being evaluated However taxpayer Information Section taxpayer or feepayer to offer a lesser amount for Taxpayers Rights Advocate TDD service for the hearing impaired: TELEPHONE NUMBER TELEPHONE NUMBER that arose from transactions in which you did that does not have and will not have in the foreseeable that may have inherited tax liabilities of the the ability to make monthly payments that the account for the periods covered by this offer In addition the BOE will retain any and all amounts to which the tax or feepayer(s) The BOE may continue collection activities at its discretion The BOE will strive to process your offer the county in which they were recorded The taxpayer or feepayer making the offer will receive copies of the lien release documents the deposit to my liability? The following documentation must be submitted The following facts and reasons are submitted as grounds for acceptance of this offer the Internet or you prefer to speak to someone The Offer in Compromise (OIC) program is for taxpayers the offer will be retained the offered amount However prior payments the OIC Section at 916 322 7931 time excluding state holidays time generally from five to seven years The TITLE TITLE TELEPHONE NUMBER to collect within a reasonable period of time to make installment payments and the offered to the BOE representative handling your to those offers that include repayment to your representative Use BOE 392 Power of Toll free number 888 324 2798 tOtAL tOtAL [Enter receivable amount on line 10 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter receivable amount on line 24 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 11 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 12 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 19 Section 6 (Asset and Liability Analysis)] >> TOTAL [Enter this amount on line 2 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 3 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 5 Section 6 (Asset and Liability Analysis)] >> tOtAL [Enter this amount on line 9 Section 6 (Asset and Liability Analysis)] >> TOTAL AMOUNT FROM OTHER SOURCES TOTAL AMOUNT OF THE LOAN TOTAL AMOUNT OF THE OFFER tOtAL CurreNt ASSetS >> tOtAL eXPeNSeS >> tOtAL INCOme >> tOtAL LIABILItIeS >> tOtAL OtHer ASSetS >> towards the offered amount as long as the total TRADE OR BUSINESS NAME BUSINESS ADDRESSES OR CORP NUMBER TELEPHONE NUMBER FEIN trust or organization) both the individual application Trusts TYPE BROKERAGE NAME OWNER OF RECORD Under penalty of perjury I declare that I have examined the information given in this statement and all other documents included Unidentified Business Organizations Unless you have been otherwise directed you must us to direct questions or requests for information use tax liability use tax reimbursement and the taxpayer has not VALUE Van Nuys 818 904 2300 Vehicle Information Vehicles Ventura 805 677 2700 Verification of Income and expenses we will have a decision to you within 180 We will only process your OIC application if: West Covina 626 480 7200 Visit us on the Internet www boe ca gov When should offered funds be submitted? WHERE where you are the lessor or lessee while my offer is being evaluated? who have experience with the OIC process Who Qualifies? Who should use this application? will be denied and all funds received through Will collection action be suspended while will exceed the amount offered we will work will process all the necessary adjustments to your account balance Releases of liens (if applicable) will be mailed directly to Will the BOe automatically approve my with the OIC Application Please submit copies with this offer and to the best of my knowledge and belief they are true correct and complete with you to establish an Installment Payment within that time Investment account statements www boe ca gov If you do not have access to www boe ca gov or call the number listed above YEAR MAKE MODEL LICENSE NUMBER LENDER/PINK SLIPHOLDER YEAR MAKE MODEL OF VEHICLE DESCRIPTION OR PROPERTY ADDRESS WHO TOOK TITLE OR POSSESSION VALUE Year to date income and expense statements years Yes You are required to continue making timely you can contact your local district office you send us Additional documentation may be You will be notified when your offered amount your account If you do not know the name of the