The Oregon Statement form, or Form OR-SFC, serves as a comprehensive disclosure of an individual's or business entity's financial condition. It is a required document for taxpayers in Oregon who are seeking suspended collection status or a modification of wage garnishment, outlining detailed financial information including assets, liabilities, income, and expenditure. Failure to fully complete the form can impede its processing and may result in continued collection efforts by the state, such as garnishment, the placement of a lien, or the assignment of the debt to a collection agency.
In the realm of financial disclosure in Oregon, the Oregon Statement Form OR-SFC plays a pivotal role, particularly for individuals facing collection activities from the state. This comprehensive document demands thoroughness—requiring the completion of all sections to avoid the continuation of collection efforts that could lead to garnishment, lien, or the debt being handed over to a private collection agency. Designed to paint a detailed picture of one's financial condition, the form entails the submission of not only personal and, if applicable, business bank statements from the last three months but also pay stubs for individuals and profit and loss statements for businesses. Additional sheets are allowed for those who need more space to provide comprehensive information, highlighting the form's adaptability to complex financial situations. Significantly, options are available for individuals to apply for suspended collection status or wage garnishment modification, which underscores the form's role in providing pathways to financial relief under specific conditions. Moreover, detailed sections on employment information, general financial details—including bank accounts, safe deposit boxes, vehicles, personal property, life insurance, securities, and real estate—underscore the depth of financial analysis required. This meticulous documentation is geared towards both personal and business financial landscapes, reinforcing the necessity of transparency in one's financial dealings with the Oregon Department of Revenue. By delving into assets and liabilities analysis, the form equips the state with a granular view of an individual's or a business entity's financial status, facilitating informed decisions regarding collection processes or eligibility for certain financial reprieves.
Form OR-SFC
Statement of Financial Condition
Return by:
Complete all sections of this form. If you don’t complete all sections of this form, we can- not process it, which will continue collection activity. This may result in garnishment, lien, or assignment of debt to a private collection agency.
Three months of current bank statements—personal and business (if applicable). Three months of current pay stubs (if applicable).
Three months of profit and loss statements (for businesses only).
•All household income.
Additional sheets, as needed, for additional information.
Check here if applying for suspended collection status. For suspended collection status qualifications, visit www.oregon.gov/dor and search for “Suspended collection.”
Check here if applying for a wage garnishment modification.
Revenue use only
Date received
Revenue agent
Section 1. Personal information
Your irst name
MI
Last name
Your Social Security number
– –
Your date of birth
Other names or aliases used
Spouse/RDP’s irst
Spouse/RDP’s Social Security number
Spouse/RDP’s date of birth
name
–
Spouse/RDP’s other names or aliases used
Your cell phone
Your driver license number
State
Spouse/RDP’s cell phone
Spouse/RDP’s driver license no.
(
)
Your email
Spouse/RDP’s email
Dependent’s name (living with you)
Date of birth
Social Security number
Relationship
Your current physical address
City
ZIP code
County
Your home phone
()
Your mailing address (if different from above)
Name of your tax representative (CPA, attorney, enrolled agent)
Fax number
Phone
Address of your tax representative
Section 2. Employment information (personal and business)
Your employer or business name
Business phone
Payroll fax
Address
Date hired:____________________
Occupation: _______________________________
Wage earner
Sole proprietor
Partner
Owner oficer
Paid:
Weekly
Every other week
Monthly
Twice a month
Number of allowances claimed on Form W-4:____________________
150-101-159 (Rev. 01-17)
Form OR-SFC, Financial Statement—Page 1
Section 2. (continued) Employment information (personal and business)
Spouse/RDP’s employer or business name
If self-employed: List all responsible owner(s), partner(s), oficer(s), major shareholder(s), etc.
Identify the major responsibilities of each by circling the codes that apply: 1 = Files returns; 2 = Pays taxes; 3 = Prefers creditors; 4 = Hires and ires
Name and title
Effective date
Home address
Home phone
SSN
Code
1
2
3
4
Section 3. General inancial information (personal and business)
Bank accounts. Include IRA and retirement plans certiicates of deposit, etc. For all accounts, attach copies of your last three bank statements. Attach additional pages as needed.
Name of institution
Type
Date opened
Account number
Balance
Total. Enter this amount on line 2, Section 4 (asset and liability analysis)........................
$
Safe deposit boxes (rented or accessed). Include location, box number, and contents. Attach additional pages as needed.
Box identiication
Current value of assets
Total. Enter this amount on line 3, Section 4 (asset and liability analysis)........................
Vehicles. Attach supporting documentation of current payoff. Attach additional pages as needed, and vehicles paid in full.
Year, make, model, license number
Lender/lien holder
Current market value
Current payoff
Available equity
(cannot be less than -0-)
Total. Enter this amount on line 4, section 4 (asset and liability analysis) ........................
Form OR-SFC, Financial Statement—Page 2
Section 3. (continued) General inancial information (personal and business)
Personal property. Include water craft, RVs, air craft, business equipment, and/or machinery. Attach additional pages as needed.
Total. Enter this amount on line 6, section 4 (asset and liability analysis) ........................
Life insurance. Attach additional pages as needed.
Name of insurance company
Agent’s name and phone
Policy number
Face amount
Loan/cash
surrender value
Total. Enter this amount on line 7, section 4 (asset and liability analysis) ........................
Securities. Include stocks, bonds, mutual funds, money market funds, securities, 401(k), etc. Attach additional pages as needed.
Where located
Owner of record
Quantity or denomination
Current value
Total. Enter this amount on line 8, section 4 (asset and liability analysis) ........................
Real property. Include a copy of the deed and a copy of homeowners/rental insurance policy with riders and supporting documentation of loan balance. Attach additional pages as needed.
A. Physical address
(single- or multi-family dwelling,
lot, rental, etc.)
Mortgage lender’s name and address
Parcel number:_______________
How is title held:______________________________________ Purchase price: _________________ Purchase date: __________________
Current market value: _______________________Mortgage balance: ___________________________ Equity: ___________________________
B. Physical address
C. Physical address
Form OR-SFC, Financial Statement—Page 3
D. Physical address
Total Equity. Enter this amount on line 9, Section 4 (asset and liability analysis) . . . . . . . . .
Credit cards and lines of credit. Credit cards and unsecured lines of credit may only be allowed with three months of statements showing they are used for living expenses.
Type of account
Name and address of creditor
Monthly payment
Credit limit
Credit available
Amount owed
Total $
Total. Enter this amount on line 28, Section 4 (asset and liability analysis)
Other inancial information. Please provide the following information relating to your inancial conditions. If you check “Yes” in any box, provide dates, an explanation, and documentation. Attach additional pages as needed.
Court proceedings
No
Yes _______________________________________________________________________________
Repossessions
Anticipated increase in income
Bankruptcies/receiverships
Recent transfer of assets
Beneiciary to trust, estate, proit sharing, etc. ...
Last Oregon income tax return iled
Year:_______ _______________________________________________________________________________
Total number of exemptions claimed
___________ ________________________________________________________________________________
Adjusted gross income from return
$__________ ________________________________________________________________________________
List any vehicles, equipment, or property sold, given away, or repossessed during the past three years. Attach additional pages as needed.
Year, make, model of vehicle, or property address
Who took possession
Value
Form OR-SFC, Financial Statement—Page 4
Section 4. Assets and liability analysis
Immediate assets.
Totals
1.Cash
2.Bank accounts / balance (from section 3)
3.Safe deposit box value of contents (from section 3)
4.Enter vehicles equity (from section 3)
5.Vehicle equity formula (line 4 - $3000, if less than -0-, enter -0-) This line for use on form 150-101-157, Settlement Offer Application only.
6.Personal property (from section 3)
7.Loan / cash surrender value for life insurance (from section 3)
8.Securities (from section 3)
9.Current real estate equity (from section 3)
10.Notes
11.Accounts receivable
12.Judgements / settlements received or pending
13. Interest in trusts
14. Interest in estates
15. Partnership interests
16. Major machinery / equipment, etc.
17. Business inventory
18. Other assets: (specify): (Example: $1,000 guns / $200 jewelry / $800 gold)
19. Other assets (specify):
20. Total assests
Real property equity. From Section 3. Liens or cost of sale don’t reduce equity (can’t be less than -0-).
Address or location
RMV from property tax statement
Mortgage payoff amount
Equity
21.
Property 1:
22.
Property 2:
23.
Property 3:
24. Total equity from properties listed on additional sheet (if applicable)
25.
Total of all real property equity (add the Equity column from lines 21 thru 24)
26. Enter dollar amount from line 20
27. Total value of all immediate assets and real property equity (line 25 plus line 26)
Current liabilities. Include judgements, notes, and other charge accounts. Do not include vehicle or home loans.
28.Amount owed to credit cards and lines of credit (from Section 3)
29.Taxes owed to IRS (provide a copy of recent notices)
30.Other liabilities (specify):
31.Other liabilities (specify):
32.Other liabilities (specify):
33. Total liabilities
Form OR-SFC, Financial Statement—Page 5
Section 5. Monthly income and expense analysis
Income. Attach copies of all income sources that contribute to household expenses (minimum three months).
List Net Income
34.
Wages / salaries / tips (yours)
35. Social Security income (yours)
36.
Pension / annuities (yours)
pension
annuities
both
37.
Disability (yours)
38. Wages / salaries / tips (spouse/RDP’s)
39.Social Security income (spouse/RDP’s)
40.Pension / annuities (spouse/RDP’s) pension annuities both
41.Disability (spouse/RDP’s)
42.Interest / dividends / royalties (average monthly)
43.Payments from trust / partnerships / entities
44.Unemployment
45.Other income (specify)
46.Other income (specify)
47.Other income (specify)
List Gross Income
48. Business income (yours)
49.Business income (spouse/RDP’s)
50.Rental income
51.Child support
52.Alimony
53.Seller carried contracts / sales
54. Total income
Personal expenses (actually paid). (May be limited by federal standards.)
55. Rent / mortgage / real estate secured line(s) of credit
If renting—name, address, and phone number of landlord
Amount
56.
Real estate taxes
(Is this included in your mortgage payment?
Yes)
57. Personal home owners / renters insurance: (
) Assoc. fees: (
58. Personal utilities:
Electric: (
Natural gas / oil: (
Phone, internet, & cable: (
Garbage: (
Water / sewer: (
59.
Food / clothing / other Items: No. of people: (
Their ages: (
60. Auto payments / lease
61.
Auto insurance
62. Auto maintenance / fuel / other transportation
63.Medical payments (not covered by insurance) (provide proof)
64.Estimated tax payments (provide proof)
65.Court ordered payments (alimony, child support, restitution, not deducted from your paycheck)
Form OR-SFC, Financial Statement—Page 6
Section 5. (continued) Monthly income and expense analysis
Personal expenses (actually paid). (continued) (May be limited by federal standards.)
66.Garnishments (specify)
67.Delinquent tax payments (other than Oregon state taxes, IRS, etc.)
68.Work related child care expenses
69. Other expenses (do not include unsecured debt) (specify)
70. Total personal expenses
Business expenses (actually paid). Provide current general ledger and proit / loss.
71. Materials purchased (specify)
72.
Supplies (specify)
73. Installment payments (specify)
74.
Monthly payments (specify)
75. Rent / mortgage
76.
Insurance
77. Business utilities: Electric: (
78.
Net wages and salaries paid to employees
79. Current taxes (payroll / business)
80. Other: Specify: (do not include unsecured debt)
81.
Total business expenses
82. Net disposable income (line 54 minus lines 70 and 81)........................................................................................................
Section 6. Additional information
Please provide any additional information not already included. Attach additional pages as needed. All household income must be included.
Form OR-SFC, Financial Statement—Page 7
Section 6. (continued) Additional information
Your proposed monthly payment.....................................................................................................................
Your proposed payment date...........................................................................................................................................
Section 7. Authorization to disclose
Under penalties of perjury, I declare that I have examined this statement of assets, liabilities, and other information, and to the best of my knowledge and belief, it is true, correct, and complete. I (we) authorize the Oregon Department of Revenue to verify any information on this inancial statement which may include credit reports.
Sign here
X
Your signatureDate
Spouse’s signature (if applying jointly, both must sign even if only one had income)
Date
Return your completed form to: Oregon Department of Revenue
PO Box 14725
Salem OR 97309-5018
Form OR-SFC, Financial Statement—Page 8
Filling out the Oregon Statement of Financial Condition form is an important step for anyone who finds themselves in a situation where they need to present their financial standing comprehensively to the Oregon Department of Revenue. This could be due to various reasons such as applying for suspended collection status or modifying a wage garnishment. It's crucial to approach this task with accuracy and thoroughness, ensuring every section is completed to avoid delays or continuation of collection activities. The instructions below aim to simplify the process.
Once all sections are accurately completed, review your information carefully to ensure its correctness. Any additional sheets needed for further information should be attached in accordance with the instructions provided in specific sections of the form. Remember, providing comprehensive and accurate information is essential to process your form effectively and avoid further collection activities from the Oregon Department oferoon Revenue.
The Form OR-SFC, Statement of Financial Condition, is designed to provide a comprehensive overview of an individual’s or business’s financial status to the Oregon Department of Revenue. Its main purpose is to assess the financial situation of a taxpayer who is facing collection activities due to unpaid taxes. By completing this form, individuals and businesses can provide details about their assets, liabilities, income, and expenses. It is also used to apply for suspended collection status or a wage garnishment modification, offering a structured way to demonstrate financial hardship and negotiate terms to address tax liabilities.
Failure to complete all sections of the Form OR-SFC can prevent the Oregon Department of Revenue from processing your form. This inaction may lead to the continuation of collection activities against you, such as garnishment of wages, imposition of liens on property, or assignment of your debt to a private collection agency. It is crucial to provide all required information and attach additional documentation as necessary to ensure your form is processed and to help you manage or resolve your tax obligations effectively.
To apply for suspended collection status or a wage garnishment modification using the Form OR-SFC, the applicant must check the relevant box provided near the top of the form. Applicants seeking suspended collection status must meet specific qualifications, which can be found on the Oregon Department of Revenue’s website. To apply for a wage garnishment modification, similar steps must be followed, including checking the appropriate box and providing detailed financial information through the form. It is advisable to visit the official website or contact the Oregon Department of Revenue directly for the most current requirements and guidelines related to these applications.
Filling out the Oregon Statement of Financial Condition (Form OR-SFC) requires careful attention to detail. Mistakes on this form can lead to issues with processing, potentially resulting in continued collection activity from the state, such as garnishment or liens. Below are seven common mistakes people make when completing this document:
Not completing all sections:
Failing to provide information in every required field can result in the form being returned or not processed, which might continue or initiate collection activities against the individual.
Omitting additional sheets for detailed information:
When the space provided on the form is insufficient, additional sheets should be used to ensure all information is thoroughly documented. Overlooking this can lead to incomplete financial disclosure.
Incorrectly reporting income sources:
All household income must be accurately reported. This includes not only traditional employment but also any business income, rental income, or other sources that may not be regular wage earnings.
Forgetting to attach three months of bank statements and pay stubs:
The form requires the attachment of these documents for a reason. They serve as proof of the financial information reported and failing to provide them can delay the reviewing process.
Missing out on checking special status boxes:
If you are applying for suspended collection status or seeking a wage garnishment modification, forgetting to check the respective box at the beginning of the form overlooks potentially beneficial considerations for your case.
Leaving out information on assets or liabilities:
Not detailing all assets and liabilities, including personal property, real estate, insurance policies, and others as requested in the form, omits a comprehensive view of your financial condition, which could impact the decision-making process.
Inadequate documentation of financial changes:
Any recent transfer of assets, court proceedings, bankruptcies, or any other significant financial events must be documented and explained. Failure to provide this information may lead to questions regarding the accuracy and completeness of the submission.
It is crucial to review the form thoroughly before submission to ensure all necessary information is accurately represented and that no required details are omitted. Correctly completing the Oregon Statement of Financial Condition is vital for a fair assessment of one's financial status by the Department of Revenue.
When preparing or complementing the Oregon Statement of Financial Condition (Form OR-SFC), several key documents and forms are often used alongside to provide a full financial overview. These documents are essential for accurately portraying an individual's or business's financial state, ensuring that the Oregon Department of Revenue can make informed decisions regarding collection activities, suspended collection status, or wage garnishment modifications.
Together, these documents play a pivotal role in complementing the information provided in the Oregon Statement of Financial Condition. They ensure a comprehensive and accurate representation of financial status, facilitating a more informed and equitable assessment process by the Oregon Department of Revenue.
The Oregon Statement form shares similarities with the IRS Form 433-A, "Collection Information Statement for Wage Earners and Self-Employed Individuals." Both documents require detailed personal and financial information, including employment details, income sources, bank account balances, and an asset and liability analysis. They are used to assess an individual’s financial situation to determine payment plans or settlement options for outstanding tax liabilities, highlighting their use in managing and resolving tax-related debts.
Comparable to the Uniform Residential Loan Application used in the mortgage industry, the Oregon Statement form gathers comprehensive financial data from applicants to evaluate their ability to meet financial obligations. Both forms collect detailed information on income, employment, assets, liabilities, and real estate owned, facilitating a thorough financial review by the requesting entity to make informed decisions regarding loan approval or, in the case of the Oregon Statement, tax debt resolution options.
The Consumer Financial Statement that credit counseling agencies often utilize reflects similarities with the Oregon Statement form in its purpose to outline an individual's financial status comprehensively. Each document collects extensive details on personal finances, including debts, monthly expenses, income, and assets, enabling the counselor or tax authority to advise on debt management plans or tax payment agreements effectively.
Business financial statements, like the Oregon Statement form when used for businesses, provide a snapshot of the financial health of a company. These documents include profit and loss statements, balance sheets, and cash flow statements, comparing to the Oregon form's requirements for business financial information, including bank statements and profit and loss statements if applicable. This comprehensive financial data assists in assessing the business’s ability to manage and satisfy debt obligations.
The Statement of Financial Affairs, a required document in bankruptcy filings, shares its core purpose with the Oregon Statement form by offering a detailed account of the debtor's financial situation. Both documents request information on assets, liabilities, income, and significant financial transactions to provide a clear picture of the financial status of the individual or business, playing a critical role in debt resolution processes.
Financial affidavits used in various legal settings, including divorce proceedings, bear resemblance to the Oregon Statement form in their detailed collection of financial information. These affidavits require full disclosure of income, expenses, assets, and liabilities to determine financial responsibility and division of assets or debts. Similarly, the Oregon Statement form gathers this information to assess an individual's or business’s fiscal condition for tax debt resolution purposes.
Lastly, loan modification applications mirror the Oregon Statement form in terms of financial scrutiny. Both require detailed documentation of the applicant's financial situation, including income, assets, liabilities, and monthly expenses, to evaluate eligibility for modifying the terms of an existing loan or for tax relief mechanisms. This process is crucial for institutions or agencies to make informed decisions based on the applicant’s ability to meet revised payment terms or tax obligations.
When completing the Oregon Statement of Financial Condition (Form OR-SFC), understanding what to do and what not to do is crucial for a smooth process. Here is a list to guide you:
Do's:
Don'ts:
When it comes to understanding and filing the Oregon Statement of Financial Condition form (Form OR-SFC), there are several misconceptions that can lead to confusion. It's crucial to have accurate information to properly complete the form and avoid potential issues with the Oregon Department of Revenue. Here are five common misconceptions:
Understanding these misconceptions and the actual requirements of the Oregon Statement of Financial Condition form can help individuals and business owners complete it accurately and effectively. This not only helps in providing the necessary information to the Department of Revenue but also in potentially avoiding further collection actions.
Filling out the Oregon Statement of Financial Condition form is crucial for accurately representing a person's financial state, particularly when facing collection activities or seeking modifications to existing debt terms. Here are nine key takeaways for completing and utilizing this form effectively:
Following these guidelines ensures the Oregon Statement of Financial Condition form is filled out comprehensively, aiding individuals in accurately conveying their financial situations for review by the Oregon Department of Revenue.
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