Fillable PktS Application For Settlement Of Tax Liability (Oklahoma)

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PktS Application For Settlement Of Tax Liability (Oklahoma)

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Application
for Settlement
of Tax Liability
Oklahoma Tax Commission
Account Maintenance Divison - AMW
Post Ofce Box 26800
Oklahoma City, Oklahoma 73126-0800
Packet S
Revised December 2018
This Packet Contains:
• Instructions
• Application for Settlement of Tax Liability - Form OTC-600
• Statement of Financial Condition for Individuals - Form OTC-600-A
• Statement of Financial Condition for Businesses - Form OTC-600-B
• Worksheet to Calculate Collection Potential - Form OTC-600-C
• Document Checklist - Form OTC-600-D
• Authorization to Release Financial Data - Form OTC-600-E
• Power of Attorney - Form BT-129
This page has been
intentionally left blank
What Are the Grounds for Requesting a Settlement of Tax Liability?
The Oklahoma Tax Commission, as authorized by Oklahoma Statutes, Title 68, Section 219.1, will consider a settlement of
tax liability when it is determined that:
A. Collection of the tax, and interest and penalties accruing thereto, would reasonably result in the taxpayer declaring
bankruptcy;
B. The tax is uncollectible due to insolvency of the taxpayer resulting from factors beyond the control of the taxpayer
or for other similar cause beyond the control of the taxpayer;
C. The tax liability is attributable to actions of a person other than the taxpayer and it would be inequitable to hold the
taxpayer liable for the tax liability; or
D. In cases of nonpayment of trust fund taxes, the taxes were not collected by the taxpayer from its customer and the
taxpayer had a good faith belief that collection of the taxes was not required;
Administrative rules for the settlement process are found at 710:1-5-80 et. seq. of the Oklahoma Administrative Code.
Am I Eligible?
Taxpayers are eligible to le an Application for Settlement if they believe they qualify for settlement on one or more of the
grounds referenced above and the following eligibility requirements are met:
1) The tax liability must be nal;
2) All administrative remedies and appeals must be exhausted;
3) The taxpayer must be current with all tax return ling requirements of the Commission;
4) The taxpayer must not be the subject of an open bankruptcy proceeding
5) The taxpayer must not be the subject of a State tax related criminal investigation or prosecution.
When Am I Not Eligible?
1) Settlement of liability is not available if the taxpayer does not meet one of the four grounds for settlement listed
above and all of the eligibility requirements.
2) Trust fund taxes collected, but not remitted to the Tax Commission, can not be settled for less than the amount of
tax collected.
3) Appointed or elected ofcials are not eligible to seek relief.
Information You Need to Know Before Submitting the
Application for Settlement of Tax Liability
Making an Offer for Settlement of Tax Liability
♦ An Application for Settlement of Tax Liability, OTC-600, must be submitted to the Oklahoma Tax Commission.
♦ If the settlement is requested on grounds A or B, an Application for Settlement of Tax Liability must be accompanied
by (1) the appropriate Statement(s) of Financial Condition for Individuals and/or Businesses, and (2) all documentation
required to support the facts and gures on those forms.
♦ For individual taxpayers that apply for settlement on grounds A or B, proof of employment, income, commissions, fees,
pensions, etc., must be provided for the taxpayer, spouse and dependants. Although the taxpayer may be the only
person liable for the tax, this information is needed for equitable distribution of cost of living expenses.
♦ Applications submitted by individuals who are self employed or are business owners must include Statements of
Financial Condition for both individuals and businesses.
♦ When Settlement is requested by a business, Statements of Financial Condition for Individuals may also be required
of corporate ofcers or business partners.
♦ If the settlement is requested exclusively on grounds C or D, no Statements of Financial Condition is required. Additional
documentation in support of the taxpayerʼs claim may be requested based on individual circumstances.
♦ The Account Maintenance Division (the Division) will evaluate the Application and make a recommendation to the
Commission to accept or reject the offer. The Division may request additional documentation to verify nancial or other
information concerning the Application. The Division’s nancial investigation may require verica tion of nancial data
by visual inspection of records and personal interview.
♦ The Commission may consider additional circumstances when determining whether to enter a settlement agreement.
These circumstances may include, but are not limited to: whether the taxpayer has made efforts in good faith to comply
with the tax laws of Oklahoma; whether the taxpayer has beneted from nonpayment of the tax; and involvement of
the taxpayer in economic activity from which the liability originated.
♦ Power of Attorney must be submitted in all cases where the taxpayers designate another individual to submit their
application.
Making an Offer for Settlement of Tax Liability
Continued...
If the Settlement Application Is Accepted
The Division will notify the applicant by mail if the Application is accepted. Payment of the accepted settlement offer must
be made by the payment due date as indicated on the acceptance letter. Any issued and recorded tax lien subject to the
accepted settlement amount will be released and mailed upon full payment of the settlement amount. Payment of the
settlement amount by cash, cashierʼs check, money order, or charge to an approved credit card will assure faster release
of the lien. Compliance with all terms and conditions of the settlement agreement is required.
In the event the amount abated exceeds $25,000.00, the settlement agreement must be approved by Oklahoma County
District Court. In cases that require district court approval, lien releases will not be issued until the taxpayer provides
the Division with a certied copy of the Oklahoma County District Courtʼs order approving the agreement and fullls all
requirements specied in the agreement.
If the Settlement Application Is Declined
The Division will notify the applicant by mail if the application is declined. The applicant should immediately contact the
Oklahoma Tax Commission to arrange payment of the entire liability. If immediate payment of the entire liability is not
possible, the applicant may request an installment payment arrangement through the Compliance Division of the Oklahoma
Tax Commission. Oklahoma law makes no provision for appeal of a declined Application.
.
The Commission May Reject the Application as not Processable
for any of the Following Reasons:
(1) The applicant is not adequately identied (name, address, ID#, etc.) or required signatures are not provided.
(2) The settlement offer includes an amount already collected or subject to refund.
(3) The tax liability is not adequately identied.
(4) The Application does not include a statement supporting the reason for the settlement.
(5) Financial statements or other required documentation have not been included or are incomplete.
(6) The Commissionʼs records indicate noncompliance with ling of required returns.
(7) The applicant is currently under bankruptcy court jurisdiction.
(8) Power of Attorney Form BT-129, if required, has not been included.
Other Information Concerning Settlement of Tax
Liability
♦ The Commission may suspend the enforcement of collection while a settlement offer is being considered. Any
installment payment arrangement already in effect will be continued while the settlement offer is considered. Interest
and penalty will continue to accrue on any unpaid tax debt while the settlement offer is being considered.
♦ Any payment made with the Application for Settlement of Tax Liability will be applied to the outstanding liability.
Payments will not be refunded if the Application is declined or withdrawn.
♦ All information and statements provided by the applicant are subject to verication, and are submitted under oath.
♦ Any collection by the Commission prior to approving a Settlement Agreement or any refund to which the Commission
is entitled cannot be considered part of the settlement offered.
♦ Timely ling of all tax returns is required while the Application is pending and during any pay-out period allowed.
♦ Tax liens will be released only after an Application for a Settlement is accepted and all requirements of the settlement
agreement are fullled.
♦ Acceptance of an Offer in Compromise by the Internal Revenue Service does not guarantee acceptance by the
State. An Application for Settlement tendered to the Commission will be reviewed and evaluated on its own merits.
♦ No information written in this Application shall be construed as granting any legal right to any taxpayer for the
settlement of any tax liability. The decision of the Commission in denying a settlement offer shall be nal and no
right of appeal to any court may be taken from such decision.
Mail the completed Application along with all supporting schedules and documents to:
Oklahoma Tax Commission
Account Maintenance Division - AMW
PostOfceBox26800
OklahomaCity,Oklahoma73126-0800
Oklahoma Tax Commission
Application for Settlement of Tax Liability
Form OTC-600 (Page 1)
1. Applicant(s) Name and Address Social Security Number
Social Security Number
FEI Number
County
Daytime Phone Number
(area code and number)
2. Applicant(s) Mailing Address (If different from above)
3. Applicant(s) Legal Structure
Individual Proprietorship
Partnership Corporation
Trust/Estate Corporation Ofcer(s)
4. I/We agree to pay the amount of $ to settle the tax liabilities listed in Section 5 below and will pay this
amount in the following manner: (Check One Only)
Paid in full with this agreement. (Make check payable to the “Oklahoma Tax Commission”)
A deposit of $ is attached, the balance to be paid within 30 days from acceptance.
The settlement amount will be paid in monthly payments of .
Offers for settlement based on grounds A or B must complete the Worksheet for Calculation of Collection Potential.
5. Description of Tax Liabilities To Be Settled.
Tax Type
Account Number
Period(s)
Individual Income Tax
Sales & Use Tax
Corporate Income Tax
Other (Specify)
6. Grounds for settlement:
A Collection of the tax with interest and penalties would reasonably result in the taxpayer declaring bankruptcy.
B The tax liability is uncollectible due to the insolvency of the taxpayer resulting from factors beyond the control of the
taxpayer or other similar factors.
C The tax liability is the result of actions of a person other than the taxpayer and to hold taxpayer liable for the tax liability
would be inequitable.
D In case of “trust fund taxes”, the applicant must show that the tax was not collected and that the applicant had a good faith
belief that collection of the taxes was not required. (Trust fund taxes collected, but not remitted to the Commission, can not
be settled for less than the amount of tax collected.)
7. If any or all of the amount offered is from a loan or gift, provide the name of the lender or donor.
Form OTC-600 (Page 2)
8.Ifanyoralloftheamountofferedisfromasourceotherthanaloanorgift,providethenameofthesource.
9.1IfyoumarkedGroundsAorBonpageone,orarerequestingasettlementbasedinpartonnancialhardship,
provide(a)adetailedexplanationoftheeventsthatresultedinthetaxliability,(b)whythetaxwasnotledand/or
paid when it was due, and (c) the circumstances that presently prevent you from paying in full.
9.2 If you marked Grounds C or D on page one, provide a detailed explanation of the nature of the events that resulted in
the tax liability. You may also include any other information that supports your grounds for settlement.
11. Disclosure Agreement for Offer in Compromise
Amount Accepted $ or Declined $
IRS Agent Assigned
Phone Number
Tax Period(s) Covered Amount Owed
Social Security Number or FEI Number
Pending
Completed
(as of date)
(as of date)
By my/our signature(s) below, I/we authorize the Oklahoma Tax Commission and the Internal Revenue Service to exchange
information from their respective les regarding my/our pending or completed offer in Compromise.
Form OTC-600 (Page 3)
Applicantʼs Signature
Date
Power of Attorney Signature
Applicantʼs Signature
Date
Date
10. If you are represented by an attorney, accountant or agent, please provide the following contact information:
Name:
Phone Number (area code and number)
(Attach Power of Attorney - Form BT-129)
Firm:
Mailing Address:
12. Terms and Conditions
By submitting this Application and signing below, I/we are requesting from the Oklahoma Tax Commission settlement of tax
liability as authorized by O.S. 68, Section 219.1. I/we understand and agree to the Terms and Conditions of the Application for
Settlement of Tax Liability as follows:
a) I/We voluntarily submit any payment made with this Application.
b) The Commission will apply any payment made with the Application to the oldest existing tax liabilities.
c) If the Commission rejects the Application or if the Application is withdrawn, the Commission will treat any
amount paid with the Application as payment toward the outstanding tax liability.
d) I/We will remain in compliance with all tax return ling and payment provisions of Oklahoma Statutes while
this Application is pending and during the period of any subsequent pay plan arrangement.
e) The Application remains pending until an authorized Commission ofcial issues notication of acceptance or
rejection, or until the Application is withdrawn by me/us.
f) I/We understand that collection activities may continue during the review process, however, the Commission
may suspend its collection efforts if the interests of the State will not be compromised.
g) Payments and refunds applied prior to receipt of the Application by the Commission cannot be considered
part of the settlement offer and are not subject to refund.
h) I/We understand that the tax owed will remain a tax liability until all the terms and conditions of the settlement
agreement are met. If I/we le bankruptcy before the terms and conditions of the settlement agreement are
completed, any claim the Commission les in a bankruptcy proceeding will be a tax claim.
Under penalty of perjury, I/we declare that the information contained in this Application for Settlement of Tax Liability,
Attachments, and Schedules are true and correct to the best of my knowledge and belief.
Form OTC-600 (Page 4)
Applicantʼs Signature
Date
Power of Attorney Signature
Applicantʼs Signature
Date
Date
Mail to: Oklahoma Tax Commission
Account Maintenance Division - AMW
PostOfceBox26800
OklahomaCity,Oklahoma73126-0800
NOTE: If settlement is requested on grounds A or B, the Statement of Financial Condition for Individuals and/or Statement of
Financial Condition for Businesses must be completed, signed and attached along with the required supporting documentation. In
all cases, additional documentation may be requested for verication of information.
Oklahoma Tax Commission
Statement of Financial Condition for Individuals
Form OTC-600-A (Page 1)
The information requested in this statement should include all household income and expense.
Spouse and dependent information are required although only one person may be liable for the tax.
Section I - Personal Information
1.TaxpayerʼsName(s)andResidenceAddress
6. Previous Address If At Current Address Less Than Two Years
Section II - Employment Information
8.TaxpayerʼsEmployerorBusiness-NameandAddress
13.SpouseʼsEmployerorBusiness-NameandAddress
18.TaxpayerʼsPart-timeandPreviousEmployment
in Last Three Years
EmployerʼsName
Section III - Dependent Information
20. Dependent Name (Other Than Spouse)
2. Daytime Phone Number 3. Marital Status (Check One)
4. Social Security Number:
Taxpayer:
Spouse:
5. Date of Birth:
Taxpayer:
Spouse:
9. Employer Phone Number
10. Occupation
11. Length of Employment
12. Work Relationship
14. Employer Phone Number
15. Occupation
16. Length of Employment 17. Work Relationship
19.SpouseʼsPart-timeandPreviousEmployment
in the Last Three Years
Social Security
Number
Date of Birth
Relationship
Monthly Income
Employment Dates
EmployerʼsName
Employment Dates
County Do you own or rent ?
Single Married
Separated Divorced
7. Income Tax Return Information
A. Year of Last Filed Federal Income Tax Return
B. Federal Adjusted Gross Income From Last Return
C. Year of Last Filed Oklahoma Income Tax Return
$
Years Months
Years Months
Employee Proprietor
Partner Ofcer
Employee Proprietor
Partner Ofcer
To
To
To
To
To
To
$
$
$
$
$
Form OTC-600-A (Page 2)
Section IV - Assets
TOTAL (EnteralsoonPage3,Item28-A)
21. Cash on Hand
22. Bank or Credit Union Accounts (Checking,Savings,CerticateofDeposit,etc.)
BalanceType of Account
Account Number
Name of Institution and Address
TOTAL(EnteralsoonPage3,Item28-B)
23. Investments (Stocks, Bonds, Mutual Funds, IRA, Government Securities, Money Market Funds, etc.)
Type
Current
Value
Quantity or
Denomination
Issuer
TOTAL(EnteralsoonPage3,Item28-C)
24. Real Property (Personal Residence, Vacation or Second Home, Investment Property, Unimproved Land, etc.)
Equity in
Property
Amount
Owed
Current Market
Value
Address
Description
TOTAL(EnteralsoonPage3,Item28-D)
25. Vehicles - Excluding Leased Vehicles (Including Motor Homes, Campers, Motorcycles, Boats, Trailers, etc.)
Equity in
Vehicle
Amount
Owed
Current Market
Value
Tag
Number
YearModelMakeDescription
TOTAL(EnteralsoonPage3,Item28-E)
26. Other Assets
Current
Appraised Value
Furniture/Personal Effects
Current
Appraised Value
Notes Receivable
Cash Surrender Value of Life Insurance
Judgments or Settlements Receivable
Vested Retirement Account
Collectibles, Antiques or Artwork
Jewelry
Timber, Mineral or Drilling Rights
Patents or Copyrights
Other (Specify)
TOTAL(EnteralsoonPage3,Item28-F)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form OTC-600-A (Page 3)
Section V - Liabilities
27. Liabilities (Do not include any amounts owed listed in Section IV above)
Description
Total Amount Owed
Description
Total Amount Owed
Notes Payable
Installment or Personal Loans
Education or Student Loans
Bank Revolving Credit/Credit Card Debt
Judgements Payable
Past Due Federal Taxes
Past Due State Taxes
Past Due Other Taxes
Vehicle Leases
Other Liabilities
TOTAL (Enter also on Page 3, Item 29)
Section VI - Net Worth Calculation
28.Assets
29. Liabilities
30. Net Worth (“Total Assets” Minus “Liabilities”)
Total Assets
Section VII - Other Information
$
$
$
$
$
$
$
A. Cash
B. Bank or Credit Union Accounts
C. Investments
D. Real Property
E. Vehicles
F. Other Assets
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
31. Are you currently in ling compliance with all Oklahoma taxes?
If “No”, identify tax type and period:
32. If the tax liability was incurred in the operation of a business, has the business been discontinued?
Date discontinued:
33. Have you disposed of any assets or property by sale, transfer, exchange, gift, or in any other manner during the past 18 months?
If “Yes”, identify:
34. Is a foreclosure proceeding pending on any real estate that you own or have an interest in?
35. Is anyone holding any assets on your behalf?
If “Yes”, identify type of assets and value: Relationship of asset holder:
36. Are you a party to any lawsuit now pending?
37. Is there a likelihood that you will receive assets or income from an estate in probate?
If “Yes”, from whom? Relationship:
38. Have you previously petitioned the Commission for settlement of any tax liability?
If “Yes”, identify tax type and period:
39. Are you or any business that you own currently under bankruptcy court jurisdiction?
Bankruptcy Case Number:
40. Do you have income sources other than your business or employer?
If “Yes”, from whom?
41. Do you anticipate any increase in household income in the next two years?
If “Yes”, how much will the income increase? $ Why will it increase?
42. Do you have credit available on credit cards? (i.e. Visa, MasterCard) If yes, attach schedule indicating the amount available on each card.
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Form OTC-600-A (Page 4)
Section VIII - Income and Expense Analysis
43. Monthly Household Disposable Income
Gross Monthly Income
Monthly Living Expenses
Salary, Wages, Commissions and Tips
Self-Employment Income
Pensions, Disability and Social Security
Dividends, Interest and Investments
Gift or Loan Proceeds
Net Rental Income
Estate, Trust and Royalty Income
Workersʼ Compensation and Unemployment
Alimony and Child Support
Other (Specify)
Source
Taxpayer
Spouse
House or Rent Payment
Income Taxes (Federal, State, FICA)
Estimated Quarterly Tax (If Applicable)
Groceries
Medical Expenses and Prescriptions
Utilities:
Electric + Gas +
Water + Phone =
Insurance:
Life + Health +
Auto + Home =
Court Ordered Payment
Child Care
Clothing and Personal Grooming
Transportation Expense
Vehicle Loan Payment
Vehicle Lease Payment
Property and Ad Valorem Taxes
Other (Specify)
Source
Amount
Subtotal
Combined Monthly Income Total Monthly Living Expenses
44. Net Monthly Household Disposable Income (“Combined Monthly Income” Minus “Total Monthly Living Expenses”)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form OTC-600-A (Page 5)
I/We have examined this Statement of Financial Condition for Individuals and hereby afrm that to the best of my/our
knowledge and belief, it is true, correct and complete.
(Attach Power of Attorney - Form BT-129)
Applicantʼs Signature
Date
Power of Attorney Signature
Applicantʼs Signature
Date
Date
Statement of Financial Condition for Individuals
Oklahoma Tax Commission
m.c. connors building
2501 lincoln boulevard
Oklahoma City, Oklahoma 73194
Information for Completing the Statement of Financial Condition for Individuals
Form OTC-600-A (Page 6)
Income Sources
Calculating Gross Monthly Wages and Salaries:
♦ If paid weekly – multiply weekly gross wages by 4.33
♦ If paid bi-weekly (every 2 weeks) – multiply bi-weekly gross wages by 2.17
♦ If paid semi-monthly (twice each month) – multiply semi-monthly gross wages by 2
Salaries, Wages, Pensions and Social Security: Enter your gross monthly totals from these income sources.
Do not deduct payroll withholdings, allotments or other items you elect to take out of your pay, such as insurance
payments, credit union deductions, car payments, etc.
Net Rental Income: Enter your monthly net rental income. This is the amount remaining after you pay ordinary and
necessary monthly rental expenses. If your net rental income is a loss, enter “0”. Do not enter a negative number.
All income amounts are to be reported at Gross Amount except Rental Income.
Monthly Expenses
Expenses Generally Not Allowed:
♦ Tuition for private secondary schools;
♦ Tuition for public or private colleges;
♦ Charitable contributions;
♦ Voluntary retirement contributions;
♦ Payments on unsecured debts such as credit card bills;
♦ Other similar discretionary expenses.
Exceptions may be granted for expenses if you can prove that they are necessary for the health and welfare of you or
your family or for the production of income.
Oklahoma Tax Commission
Statement of Financial Condition for Businesses
Form OTC-600-B (Page 1)
(If additional space is needed, attach separate sheet)
SectionI-BusinessIdentication
1. Business Name and Address 2. Mailing Address (If Different From Street Address)
County
3. Type of Business
4. Daytime Phone Number 5. Number of Employees
6. Type of Ownership
Proprietorship Partnership
Corporation Other (Specify)
7.FederalEmployerIdenticationNumber/SocialSecurityNumber
8.BeginningDateofBusiness
9. Ending Date of Business (If Closed)
10. Last Federal Income Tax Return Filed
Tax Year Beginning
Tax Year Ended
Taxable Income
$
11.InformationAboutOwner,Partners,Ofcers,MajorShareholders,etc.
Name and Address
Social
Security Number
Title
Effective
Date
Monthly
Salary or Wage
Percent of
Ownership Interest
Section II - Assets
12. Cash On Hand
TOTAL (Enter also on Page 3, Item 24-A)
13.BankAccounts(GeneralOperating,Payroll,Savings,CerticateofDeposits,etc.)
Name and Address Account Number
Type of Account
Balance
TOTAL (Enter also on Page 3, Item 24-B)
14. Bank Credit Available (Line of Credit, etc.)
Name of Institution and Address Account Number
Credit Line
Amount Owed
Credit Available
TOTAL (Enter also on Page 3, Item 24-C)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form OTC-600-B (Page 2)
Section II - Assets (continued)
15. Real Property (Including Investment Property, Unimproved Land, etc.)
Description
Address
Current Market
Value
Amount Owed
Equity in Property
TOTAL (Enter also on Page 3, Item 24-D)
16. Vehicles (Excluding Leased Vehicles)
TOTAL (Enter also on Page 3, Item 24-E)
Amount Owed
Current Market
Value
Description
Make
Model Year
Tag
Number
17. Accounts Receivable
Name
Date Due Status
Amount Due
TOTAL (Enter also on Page 3, Item 24-F)
18.LoansFromBusinessToProprietor,Partners,Ofcers,ShareholdersorOthers
Name
Relationship
Payoff Date
Status
Amount Due
TOTAL (Enter also on Page 3, Item 24-G)
19. Machinery and Equipment (Including Furniture, Fixtures, Business Machines, etc.)
Description
Current Market
Value
Amount Owed
Equity in
Mach. and Equip.
TOTAL (Enter also on Page 3, Item 24-H)
20. Merchandise Inventory (Goods Held for Sales and/or Raw Materials Used in Manufacture Fabricaton of Production)
Description
Current Market
Value
Amount Owed
Equity in Inventory
TOTAL (Enter also on Page 3, Item 24-I)
Equity in Vehicle
$
$ $
$
$ $ $
$
$
$
$
$
$ $ $
$
$ $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Form OTC-600-B (Page 3)
Section II - Assets (continued)
21. Investments (Stocks, Bonds, Mutual Funds, Government Securities, Money Market Funds, etc.)
Type Issuer
Quantity or
Denomination
Current Value
TOTAL (Enter also on Page 3, Item 24-J)
22. Other Assets
Type
Current or
Appraised Value
Description
Current or
Appraised Value
TOTAL (Enter also on Page 3, Item 24-K)
Section III - Liabilities
23. Liabilities
Description Total Amount Owed Description Total Amount Owed
Notes Payable (not secured by assets)
Loans Payable (not secured by assets)
Vehicle Leases (not listed above)
Equipment Leases (not listed above)
Judgements Payable
Past Due Federal Taxes
Past Due State Taxes
Past Due Other Taxes
Other Liabilities:
TOTAL (Enter also on Page 3, Item 25)
Section IV - Net Worth Calculation
24. Assets
A. Cash
B. Bank Accounts
C. Bank Credit Available
D. Real Property
E. Vehicles
F. Accounts Receivable
G. Loans From Business to Proprietor, Partners, Ofcers, Shareholders or Others
H. Machinery and Equipment
I.
Merchandise Inventory
J. Investments
K. Other Assets
Total Assets
25. Liabilites
26. Net Worth (“Total Assets” Minus “Liabilities”)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
29. Is this business currently in ling compliance with all Oklahoma taxes?
Form OTC-600-B (Page 4)
Section V - Income and Expense Analysis
27. Average Monthly Business Income and Expenses for the Periods Beginning and Ending
Accounting Method: (Check One) Cash Accrual Other:
Income Amount Expenses Amount
Gross Receipts from Sales, Services, etc.
Gross Rental Income
Interest and Investment Income
Dividends and Capital Gain Distribution
Royalty Income
Commissions
Other Income (Specify)
Materials Purchased
Net Wages and Salaries
Rent or Mortgage Expenses
Supplies and Ofce Expenses
Utilities
Transportation Expenses
Repairs and Maintenance
Insurance
Current Taxes
Bad Debts
Travel and Entertainment
Advertising
Other Expenses (Specify)
Total Income
Total Expenses
28.AverageMonthlyNetIncome(IncomeminusExpenses)
Section VI - Other Information
$
$
$
$
$
Yes No If “No”, identify tax type(s) and period(s):
30. Has this business disposed of any assets or property by sale, transfer, exchange, gift, or in any other manner during the past 18 months?
Yes No If “Yes”, receiving party:
31. Is a foreclusure proceeding pending on any real estate, equipment or other property that this business owns or has an interest in?
Yes No
32. Is another party holding any assets on behalf of this business?
Yes No If “Yes”, identify:
33. Is this business a party to any lawsuit now pending?
Yes No
34. Is this business currently under bankruptcy court jurisdiction?
Yes No If “Yes”, Bankruptcy Case Number:
35. Does the business have credit available on credit cards? (i.e. Visa, MasterCard, American Express) If yes, attach a schedule of available credit.
Yes No
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Installment and Lease Payments
Form OTC-600-B (Page 5)
I/We have examined this Statement of Financial Condition for Businesses and hereby afrm that to the best of my/our
knowledge and belief, it is true, correct and complete.
(Attach Power of Attorney - Form BT-129)
Applicantʼs Signature
Date
Power of Attorney Signature
Applicantʼs Signature
Date
Date
Statement of Financial Condition for Businesses
Oklahoma Tax Commission
m.c. connors building
2501 lincoln boulevard
Oklahoma City, Oklahoma 73194
Worksheet for Calculation of Collection Potential
This worksheet is used to assist in calculating collection potential, and may be used as a basis for the settlement amount offered in
Section Four of the Application For Settlement of Tax Liability. Statement(s) of nancial condition, Form OTC-600-A for individuals and
Form OTC-600-B for businesses, should be completed before calculating the amount of collection potential.
Before calculating collection potential, deduct monthly state tax payment amounts from expenses used to determine dispos-
able income, and deduct the amount of the state tax debt from liabilities used to determine net worth.
If the settlement will be paid within 90 days, use the totals from Column A.
If the settlement will be paid in more than 90 days but less than two years, use the totals from Column B.
1) Net Monthly Household Disposable Income
2) Multiply line 1 by:
3) Income Potential
4) Net Worth
5) Total Collection Potential (line 3 plus 4)
$
=
+
=
$
=
+
=
x48 x60
Note: Use $0.00 on Line 1 if the net income calculated on Form OTC-600-A is a negative amount. Use $0.00 on Line 4 if
the net worth calculated on Form OTC-600-A is a negative amount.
For Individuals
A
B
6) Average Monthly Net Business Income
7) Multiply line 1 by:
8) Income Potential
9) Net Worth
10) Total Collection Potential (line 8 plus 9)
$
=
+
=
$
=
+
=
x48 x60
Note: Use $0.00 on Line 6 if the net income calculated on Form OTC-600-B is a negative amount. Use $0.00 on Line 9 if
the net worth calculated on Form OTC-600-B is a negative amount.
For Businesses
11) Total Value for Individuals (line 5 above)
12) Total Value for Businesses (line 10 above)
13) Total Collection Potential (line 11 plus 12)
+
=
+
=
For Self-Employed Individuals and Business Owners
Form OTC-600-C
(Amounts may need to be adjusted to avoid duplication of asset and income values.)
Oklahoma Tax Commission
Application for Settlement of Tax Liability
Document Checklist
Form OTC-600-D
AnapplicationsubmittedpursuanttotheprovisionsofTitle68O.S.Section219.1willrequireanin-depth
analysisofyournancialcondition.Toexpeditethisprocess,itisnecessarythatyouprovidethefollowing
additional information and documents along with your initial application.
Provide proof of gross earnings, pension, social security and other income, including statements showing
deductions for the past three months.
Provide copies of federal income tax returns for three most current years, and copy of your IRS Offer-in Com-
promise agreement.
Provide copies of bank statements for all checking and savings accounts, personal and business, for the three
most current periods.
Provide copies of statements, showing the value of your interest in all retirement accounts, pensions, and
prot sharing plans for the three most current periods.
A list of all stocks, bonds, and/or other securities you own, along with the current market value for each. Pro-
vide the most current brokerage statements where available.
A statement from the insurance company for each life insurance policy showing the current cash loan value,
accumulated dividends and interest, dates and amounts of policy, loans, and the amount of loan.
Statements for all mortgages of real estate you own or have interest in. Also appraisals, if any, on all real es-
tate you own or have interest in.
Statement from lending institutions and other creditors that clearly indicates current balances owed, and pay-
ment schedules on all notes payable and/or revolving accounts.
A complete inventory of the content of all safe deposit boxes in which you have an interest, including fair mar-
ket value of each item, copies of documents, etc.
Copies of any judgements or legal decrees, (excluding bankruptcy), for past six years.
Copies of medical bills not covered by insurance and documentation from insurance company indicating the
items are not covered.
Copies of expenses including utilities, rent, insurance, property taxes for last ninety days.
A list of all your business equipment, ofce furniture, and other business assets, including fair market value of
each item, copies of documents, etc.
A list of all accounts and loans receivable, showing the payer, amount due, age, and status of each account.
Return this document checklist with your Application For Settlement of Liability, Statement(s) of Financial
Condition and Worksheet for Calculation of Collection Potential (if needed). For any item above that is not
required, mark “NA”.
Form OTC-600-E
Oklahoma Tax Commission
m.c. connors building
2501 lincoln boulevard
Oklahoma City, Oklahoma 73194
To Whom It May Concern:
You have my authorization to release any nancial data that pertains to me or my company to the Oklahoma Tax Commission.
Sworn to and subscribed before me on the date of rst above written.
Taxpayer 1 Name
Social Security Number
Address
City, State, Zip Code
Taxpayer 2 Name
Social Security Number
DBA
Address
City, State, Zip Code
Federal Employer Identication Number
Date
Signature
My commission expires:
(Notary Public)
Authorization to Release Financial Data
Address
City, State, Zip Code
DBA
Address
City, State, Zip Code
Federal Employer Identication Number
Signature
Date
Oklahoma Tax Commission • 2501 North lincoln boulevard
Oklahoma City, Oklahoma 73194
Power of Attorney
(Please Type or Print)
Note:Ifyouappointanorganization,rmorpartnership,youmustalsonameanindividualwithintheorganizationtoactonyourbehalf.
Hereby appoints:
As attorney(s)-in-fact to represent taxpayer before the Oklahoma Tax Commission and/or acquire any tax form(s) and/or documents
that taxpayer would be entitled to receive.
Type of Tax
(Income, Sales, Etc.)
State Tax Number or
Description of Tax Document
Year(s) or Period(s)
(Date of death if Estate Tax)
The attorney(s)-in-fact (or either of them) are authorized, until written revocation is received, to represent the taxpayer before the
Oklahoma Tax Commission and receive condential information and to acquire any and all tax form(s) and/or documents that the
principal(s) can receive with respect to the above specied matter(s) unless exceptions are noted below:
Retention/revocation of prior power(s) of attorney. The ling of this power of attorney automatically revokes all earlier power(s) of
attorney on le with the Oklahoma Tax Commission for the same matters and years or periods covered by this document.
If you do not want to revoke a prior power of attorney, check here ..................................................................................................
Attach a copy of any power of attorney you want to remain in effect.
Form BT-129
Revised 6-2018
▼
Taxpayer name and address
Representative(s) name and address
Representative(s) name and address
Social Security/Federal Employer Identication Number(s)
Daytime telephone number
Daytime telephone number
Daytime telephone number
Permit number(s)
Fax number
Fax number
Declaration of Representative
Under penalties of perjury, by my signature below, I declare that:
• I am authorized to represent the taxpayer identied above for the matter(s) specied there; and
• I am one of the following:
Attorney – a member in good standing of the bar of the highest court of the jurisdiction shown below
Certied Public Accountant – duly qualied to practice as a certied public accountant in the jurisdiction shown below
Enrolled Agent – enrolled as an agent by the Internal Revenue Service per the requirements of IRS Circular 230
Ofcer – a bona de ofcer of the taxpayer organization
Full-Time Employee – a full-time employee of the taxpayer
Family Member – a member of the taxpayer’s immediate family
Tax Return Preparer
Other _________________________________________________________________________________________
Taxpayer(s) signature and date. If signed by a corporate ofcer, partner or duciary on behalf of the taxpayer, I certify that I
have the authority to execute this power of attorney on behalf of the taxpayer
Signature Title (if applicable)
Date
Type or print your name below if signing for a taxpayer who is not an individual.
Name
Signature of Representative
Title (if applicable)
Title (if applicable)
Date
Date
Looking for Additional Information?
No matter what the tax topic, from ad valorem taxes to sales tax rates to tag agent locations,
the Oklahoma Tax Commission invites you to visit us on the web at www.tax.ok.gov to get
any additional information you might need.
Not only will you nd forms, publications, motor vehicle information and everything in
between, but you are also able to reach us through the “Contact” link on each page.
Still can’t find what you need?
Contact our Taxpayer Service Center at (405) 521-3160.
Oklahoma Tax Commission
Account Maintenance Division AMW
PostOfceBox26800
OklahomaCity,Oklahoma73126-0800
U.S. Postage Paid
Oklahoma City, OK 73194
PermitNumber548
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PktS Application For Settlement Of Tax Liability (Oklahoma)

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Completed 15 July 2020

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