Virginia OIC Offer in Compromise Individual

OIC Offer in Compromise Individual
Offer in Compromise (OIC) Business Doubtful Collectibility Package
Form OIC-Fee	
Virginia Department of Taxation
	
Fee for Doubtful Collectibility Offer In Compromise
Name(s) 	_______________________________________________________________________________________________________________
Virginia Account Number (SSN or FEIN) ________________________________________________________________________________
Address 	 _______________________________________________________________________________________________________________
	

_______________________________________________________________________________________________________________

Daytime Telephone Number(s) _________________________________________________________________________________________
Email Address __________________________________________________________________________________________________________
For Businesses, Contact Name _________________________________________________________________________________________
Payment of $50.00 submission fee attached.
Submission Fee Waiver Request
For individuals only: I/We certify that the below conditions for exemption from the submission fee have been met.
I/We understand that the fee will be required before consideration of this offer in compromise if the Department of
Taxation finds that this certification is incorrect.
For businesses: If you believe the business is unable to pay the submission fee, check this waiver request box.
Waiver of the submission fee is not automatic. If the Department of Taxation determines that you can pay the
submission fee, payment will be required before your offer in compromise can be considered.

Instructions
In general, a submission fee of $50.00 must be paid when
you file for an offer in compromise based on doubtful
collectibility.

Waiver of Fee for Individuals
The fee does not apply if:
•	

You are an individual, or the offer in compromise
is for a sole proprietorship or a disregarded singlemember limited liability company, AND

•	

Your gross monthly household income meets the
Low-Income Certification Guidelines shown below.
Low-Income Certification Guidelines
Individuals and Sole Proprietors Only
Family Size

Gross Monthly
Income

1
2
3
4
5
6
7
8
For each additional
person add:
Va. Dept. of Taxation  1601272  Rev. 05/23

$2,831
$3,815
$4,798
$5,781
$6,765
$7,748
$8,731
$9,715
$983

Waiver of Fee for Businesses
If you believe the business is unable to pay the submission
fee, check the Submission Fee Waiver Request box
above. Waiver of the submission fee is not automatic. If the
Department of Taxation determines that you can pay the
submission fee, payment will be required before your offer
in compromise can be considered.

What to File
Attach your payment to Form OIC-Fee and place at the
front of the package that you submit.
Individual Filers: File Form OIC-Fee, Form OIC I-3, and
FIN I-1.
Business Filers: File Form OIC-Fee, Form OIC B-3, and
FIN B-1.

Where to File and Pay
Make check payable to the Virginia Department of Taxation.
Mail with your completed offer package to:
Virginia Department of Taxation
P.O. Box 2475
Richmond, Virginia 23218-2475

Virginia Department of Taxation

Form OIC B-3	
	

BUSINESS OFFER IN COMPROMISE: DOUBTFUL COLLECTIBILITY
Please read the instructions carefully before completing this form. A submission fee is required.

Business Name __________________________________________________________________________
Trading As

__________________________________________________________________________

Address 	

__________________________________________________________________________

	

__________________________________________________________________________

Email Address

__________________________________________________________________________

Contact Name, Title, and Telephone Number ___________________________________________________
Virginia Account Number or Federal Employer Identification Number ________________________________
I/We submit this offer to settle tax, penalties, and/or interest for assessment(s) as follows: (complete all that apply):
Sales Tax for the period(s) __________________________________________________________________
Employer Withholding Tax for the period(s) _____________________________________________________
Corporation Income Tax or Pass-Through Entity for the period(s) ___________________________________
Other (specify) for the period(s) ______________________________________________________________
I/We offer to pay a total of $_____________ 	 through:
†	 Full Payment within_________ days
†	 Payments of $__________ 	 a month for __________ months
†	 Other ____________________________________________________________________________
I/We hereby grant the power of attorney to act for the business entity with respect to this offer in compromise to:
Name

________________________________________________________________________________

Address 	________________________________________________________________________________
	

________________________________________________________________________________

Telephone Number _____________________________ 	 Fax Number ______________________________
Under penalties of law, the undersigned declare that this offer, including accompanying schedules and statements,
is true, accurate and complete, and grant authorization to verify any financial data by use of a credit report. The
undersigned also agree to extend the statute of limitations for collection of the debts addressed in this offer for
a period of 60 days after the date that the Department issues its determination, including any reconsiderations.
Signature of Taxpayer __________________________________________________	Date________________ 	
Printed Name of Taxpayer ________________________________________ 	Title______________________ 	
Signature of Taxpayer’s Representative ____________________________________	Date________________ 	
Attach all required documentation, including the FIN B-1: Financial Statement for Businesses and Form OIC-Fee,
Payment for Doubtful Collectibility Offer In Compromise - see instructions
Va. Dept. of Taxation  3200012  Rev. 02/23

Instructions and Conditions for Filing an Offer in Compromise
What is an offer in compromise? An offer in compromise is a request to settle an assessment of tax,
penalty, and/or interest for less than the amount assessed. Section 58.1-105 of the Code of Virginia allows
the Tax Commissioner to settle an assessment through an offer in compromise under certain circumstances,
including potential inability to collect the balance due. If you are currently experiencing financial hardship,
doubtful collectibility may exist if you can demonstrate that you cannot pay your tax liabilities in full. To enable
us to consider a claim of doubtful collectibility, you must provide a completed financial statement using the
FIN B-1: Financial Statement for Businesses. You are encouraged to provide any other supporting documentation,
such as a letter of circumstance, that will help us evaluate your claim. See Recommended Documentation below.
DO NOT USE THIS FORM if you are seeking relief because of doubtful liability, or if you are only requesting
waiver of penalty for reasonable cause. Use Form OIC B-2, Business Offer in Compromise: Penalty Waiver/
Doubtful Liability, available on our website at www.tax.virginia.gov.
DO NOT FILE AN OFFER IN COMPROMISE IF YOUR BILL IS INCORRECT. To protest the bill, contact the
Office of Customer Services at: (804) 367-8037 or P.O. Box 1115, Richmond, VA 23218-1115.
If you believe the assessment is erroneous based on an improper application of the law (as opposed to an
administrative error), you may file an administrative appeal pursuant to Sec. 58.1-1821. See Title 23 of the
Virginia Administrative Code 10-20-165 and the Virginia Taxpayer Bill of Rights for specific requirements and
time limitations for filing an appeal.
CONDITIONS FOR SUBMITTING AN OFFER IN COMPROMISE
h	 Your account must be in a current status before an offer in compromise can be considered, which means
that all returns due as of the date the offer is submitted must be filed and processed.
h	 You are not required to make a payment with your offer. If a check is submitted with the offer, it will be
deposited upon receipt. Depositing the check does not mean that the offer has been accepted.
h	 Your attorney, tax preparer, or other representative can submit an offer in compromise request form on
your behalf. Both you and your representative must sign the submitted form.
h	 You will receive a written response to inform you whether your offer has been accepted as offered,
accepted with changes, or denied. You must follow the terms of acceptance, or the acceptance will be
voided. Although there is no right of appeal in the offer in compromise process, in the case of a denial
you may submit additional information for reconsideration.
Required Documentation:
•	

Current FIN B-1: Financial Statement for Businesses fully completed.

•	

Form OIC-Fee, Payment for Doubtful Collectibility Offer In Compromise, with payment.

•	

Complete copies of the three most recent statements for each bank and investment account.

Recommended Documentation. Attach all that are applicable:
•	

A letter of circumstance, explaining your situation.

•	

A current profit and loss statement covering at least the most recent 6-12 month period.

•	

If an asset is used as collateral on a loan, include copies of the most recent statements from lender(s) on
loans, monthly payments, loan payoffs, and balances.

•	

Copies of the most recent statements of outstanding notes receivable.

•	

Copies of the most recent statements from lenders on loans, mortgages (including second mortgages),
monthly payments, loan payoffs, and balances.
Mail the completed form and attachments to:
Tax Commissioner
Virginia Department of Taxation
P.O. Box 2475
Richmond, VA 23218-2475

Form FIN B-1	
Financial Statement for Businesses
	
Note: Complete all blocks. Write N/A (not applicable) in those blocks that do not apply.
1. Taxpayer Information
Name and address of business:

Contact Phone Number:

Website:

Entity Type:
 Sole Proprietor
 Partnership
 Corporation
Name and title of person submitting offer:

 S Corp
 LLC
 Other (specify)

Employer Identification Number
(EIN):
Number of Employees:

Trade name and description of business:

Locality (City/County):
Average Gross Monthly Payroll:

2. Information about owner, partners, officers, majority shareholders, etc.
Effective
Date

Name and Title

Home Address

Phone Number

Social Security
Number

Annual
Salary

Total
Shares of
Interest

Is this business a member of an affiliated group? If Yes, list the Name(s) and Employer Identification Numbers(s):
Name

Relationship

EIN

3. General Financial Information
a.	 Bank accounts (include savings and loans, credit unions, IRA and retirement plans, certificates of deposit, etc.)
Name of Financial Institution

Address

Type of Account

Account Number

Balance

b.	 Bank credit available (lines of credit, credit cards, etc.)
Name of Financial Institution

Va. Dept. of Taxation  3200010  Rev. 02/23

Address

Credit Limit

Page 1

Amount
Owed

Credit
Available

Monthly
Payment

c.	 Real Property (brief description and
address)

Used as
Collateral

Owner of Record

1.

Amount
Owed

Value

Yes
No

Locality (City/County)
2.

Yes
No

Locality (City/County)
3.

Yes
No

Locality (City/County)
4.

Yes
No

Locality (City/County)

d.	 Life insurance policies owned with business as beneficiary
Name of Insured

Company

Policy Number

Type (Whole/Term)

Face Amount

Available Loan
Value

e.	 Vehicle Information (enter information about any cars, boats, motorcycles, RV’s, etc., owned or leased by the business)
Vehicle Description

City/State of Registration

Registered Owner

Amount
Owed

Value

1.
2.
3.

f.	 Machinery and Equipment
Description

Value

Amount Owed

1.
2.
3.

g.	 Other Assets (include any investments in pass-through entities)
Description

Value

Amount Owed

1.
2.
3.

4. Other information relating to your financial condition. If you check the “Yes” box, please give dates and explain in comments box below
Court Proceedings:

Yes	

No

Repossessions/Foreclosures:

Yes	

No

Anticipated increase in income:

Yes	

No

Delinquent Federal Taxes:

Yes	

Bankruptcies:

Yes	

No

Recent sale or other transfer of
assets for less than full value:
Participant or beneficiary to trust,
estate, profit sharing, etc.:

Yes	

No

Yes	

No

If Yes, outstanding balance: _______________		

Comments:

Page 2

No

5. Asset and Liability Analysis
Description

Current
Market
Value

Liabilities
Balance Due

Equity in
Asset

Cash on Hand
Bank Accounts
Accounts/Notes Receivable
Life Insurance Loan Value
1.
Real Property
(from Item 3 c.)

2.
3.
4.
1.

Vehicles
(from Item 3 e.)

2.
3.
1.

Machinery and
Equipment
(from Item 3 f.)

2.
3.
1.

Other Assets
(from Item 3 g.)

2.
3.

Merchandise Inventory

Other Liabilities (including Notes
and Judgments)

Federal Taxes Owed
State Taxes Owed
Local Taxes Owed
Total
Page 3

Amount of
Payment

Name/Address of Lien Holder

Date of
Final
Payment

6. Income and Expense Analysis
Indicate whether reporting:     Annually    Quarterly    Monthly
Period Beginning ___________ Period Ending ___________

Accounting method used:	

Income

Gross receipts from sales,
services, etc.

Cash	

Accrual

Expenses
Materials Purchased

Gross rental income

Net Wages and Salaries

Interest

Mortgage

Dividends

Rent

Other income (specify)

Installment Payments
Supplies
Utilities/Telephone
Gasoline/Oil
Repairs and Maintenance
Insurance
Current Taxes
Other (specify)

Total Income

Total Expenses

Net Difference (total income
minus total expenses)

7. Supplemental Questions
Are you the plaintiff or defendant?

Are you involved in any lawsuits?
No (Skip to Certification)	

Yes (Answer the questions in this section and provide a brief explanation)

  

Plaintiff	

Defendant

Lawsuit Information:	

Docket Number: ___________ Attorney Name: ____________________ Defendant Name: ___________________

				

Date Initiated: ____________ Estimated Settlement Date: ____________ Expected Award/Penalty: ____________

Comments:

Page 4

Certification:
…	 Under penalties of law, I/we declare that to the best of my/our knowledge and belief, this statement of assets,
liabilities, and other information is true, correct, and complete.
…	 I/We grant authorization to verify any financial data by use of a credit report.
Taxpayer Signature ___________________________________________ Title ___________________________________
Printed Name_ _____________________________________________________Date ____________________________
Authorized Representative Signature _ __________________________________________________________________
Printed Name ______________________________________________________Date ____________________________
Recommended documentation. Attach all that are applicable:
…	 Letter of circumstance, explaining your situation.
…	 A current profit and loss statement covering at least the most recent 12 month period.
…	 If an asset is used as collateral on a loan, include copies of the most recent statements from lender(s) on loans,
monthly payments, loan payoffs, and balances.
…	 Copies of the most recent statements of outstanding notes receivable.
…	 Copies of the most recent statements from lenders on loans, mortgages (including second mortgages), monthly
payments, loan payoffs, and balances.

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