Chapter 3-0900 Exhibit 3

Waiver of Charges Worksheet

File Number: 123456789

1. Current principal balance $_________

2. Accrued charges

a.) accrued Administrative charges $_________

b.) accrued penalty $_________

c.) accrued interest $_________

Total (Item 2a + Item 2b + Item 2c) $_________

3. Interest rate (express as percent; i.e. 5% not .05)

Monthly interest rate (annual rate/12) _________%

4. Monthly payment $_________

5. Monthly interest (Item 1 x Item 3) $_________

If Item 5>= Item 4, then charges are waived. Stop here

If Item 5< Item 4, go on to Item 6

6. Period to repay full amount of debt (months)

a) Period to repay accrued charges ________ mos .

Item 2/Item 4- (Item 1 x Item 3)

b) Period to repay principal ________ mos.

Total (Item 6a + Item 6b) ________ mos.

7. Debtor’s life expectancy (see page 2 of this exhibit; multiply that figure by 12 to convert years to months).

IF ITEM 7 IS LESS THAN ITEM 6, then all charges must be waived.

IF ITEM 7 IS GREATER THAN OR EQUAL TO ITEM 6, then charges cannot be waived.

Consider whether the accrued charges and/or principal must be compromised by completing the Compromise of Principal Worksheet.

Calculations performed by: _______________ Date: _________

Certified by: ____________________________ Date: _________

Life Table 6.3 Expectation of Life at Single Years of Age, by Race and Sex. United States, 1999. Found in “National Vital Statistics Reports, March 21, 2001, Volume 50, Number 6, page 2 (Table A and 7-12, Tables 1-3), published by the Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics, National Vital System.

Age	All Races
	Both Sexes	Male	Female
30	48.2	45.7	50.5
31	47.3	44.8	49.8
32	46.3	43.9	48.6
33	45.4	42.9	47.6
34	44.4	42.0	46.7
35	43.5	41.1	45.7
36	42.6	40.2	44.8
37	41.6	39.2	43.8
38	40.7	38.3	42.9
39	39.8	37.4	41.9
40	38.8	36.5	41.0
41	37.9	35.6	40.0
42	37	34.7	39.1
43	36.1	33.8	38.2
44	35.2	32.9	37.2
45	34.3	32.0	36.3
46	33.4	31.1	35.4
47	32.5	30.3	34.4
48	31.6	29.4	33.5
49	30.7	28.5	32.6
50	29.8	27.7	31.7
51	28.1	26.8	30.8
52	28.1	26.0	29.9
53	27.2	25.2	29.0
54	26.4	24.4	28.2
55	25.5	23.6	27.3
56	24.7	22.7	26.4
57	23.9	21.9	25.6
58	23.1	21.2	24.7
59	22.3	20.4	23.9
60	21.5	19.6	23.1
61	20.7	19.9	22.3
62	20.0	18.9	21.5
63	19.2	18.2	20.7
64	18.9	17.5	19.9
65	17.7	16.1	19.1
66	17.4	16.1	18.4
67	16.3	15.4	17.6
68	15.6	14.7	16.9
69	15	13.5	16.1
70	14.3	12.8	15.4
71	13.7	12.3	14.7
72	13.0	11.7	14.1
73	12.4	11.1	13.4
74	11.8	10.6	12.7
75	11.2	10.0	12.1
76	10.7	9.6	11.5
77	10.1	9.0	10.8
78	9.6	8.5	10.2
79	9.0	8.0	9.7
80	8.5	7.5	9.1
81	8.0	7.1	8.6
82	7.5	6.7	8.0
83	7.1	6.3	7.5
84	6.7	5.9	7.1
85	6.3	5.5	6.6