FORM # 4 TAX PROBLEM HISTORY

FORM # 4a

CONFIDENTIAL

TAX PROBLEM

STATUS & HISTORY
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Date

Month Day Year
Date
1. Who is filling out this form?

King Law Associate TaxPayer Taxpayer's spouse or other relative Taxpayer's Attorney Taxpayer's enrolled agent or CPA Other
1a.Name of associate of Morgan King's tax practice

Jeff Johnston Rattan Dhaliwal
1b. If a King Associate, please indicate:

I have Account Transcripts or state tax entity's records of account. I have other tax transcripts I have IRS or state Notice of Levy or Lien I have the name and phone number of the tax collector's representative with whom I have been in contact. I have other important documents.
2. Taxpayer's Name *

First Name Last Name
3. Spouse's name

First Name Last Name
4. Marital status

Single - never married Married and living together Married but living apart Divorced Formerly married - spouse deceased
5. Taxpayer's E-mail Address
6. Taxpayer's preferred Phone Number

Area Code Phone Number
7. Preferred way to Contact? *

E-mail Phone Either way
8. Taxpayer's current occupation:
9. Taxpayer's previous occupation:
10. Taxpayer's current state of residence:
11. Taxpayer's previous state(s) of residence within last 2 years.
11a Identify "other"
12. Taxpayer is represented by:

Attorney - being retained Attorney - dismissed or being dismissed Enrolled Agent Accountant No one at present Other Tax help person
12a IF OTHER, PLEASE IDENTIFY
13. If attorney or other tax professional has been, or is being dismissed, please name and explain why:
14. Person Mr. King should contact about this matter:

Taxpayer Taxpayer's attorney Taxpayers accountant Enrolled agent Other tax help person
14a IF OTHER, PLEASE IDENTIFY
15. Attorney's name, phone number, and email address
16. Enrolled Agent's name, phone number, and email address
17. Upload documents relevant to your problem (Max 35 pages)

Browse Files

Cancel of
18. Prior bankruptcy?

Filed bankruptcy and finished it Filed and still in bankruptcy Never filed bankruptcy Thinking about filing bankruptcy
19. Have you at any time:

1. Did a CDP - Collection Due Process appeal 2. Applied for an installment payment plan 3. Applied for an offer-in-Compromise 4. Litigated a tax issue in U.S. Tax Court 5. Been audited by the IRS and assessed additional taxes 6. Been in "non-collectible status" 7. Failed to file a tax return 8. Filed a tax return late 9. Appealed anything to a higher office or court 10. Been ruled an innocent spouse 11. Charged with tax fraud or evasion? 12. Plead to or found guilty of tax fraud or evasion 13. Applied for "innocent spouse" 14. Been audited 15. Military deferment 16. Appeared in Tax Court for any reason 17. Agreed to an extension of the statute of limitations with the IRS
20. What kind of taxes do you owe that are over 3 years old?

IRS personal income taxes IRS payroll taxes State personal income taxes State payroll taxes Sales taxes IRS tax penalties State tax penalties Other taxes Restitution for tax offense
21. HOW MUCH OWED FOR IRS INCOME TAXES?
22. HOW MUCH OWED FOR IRS PAYROLL TAXES?
23. HOW MUCH OWED FOR STATE INCOME TAXES?
24. HOW MUCH IS OWED FOR STATE PAYROLL TAXES?
25. HOW MUCH IS OWED FOR STATE TAX PENALTIES?
26. HOW MUCH IS OWED OWED FOR STATE SALES TAXES?
27. HOW MUCH IS OWED FOR IRS PENALTIES?
28. HOW MUCH IS OWED FOR OTHER TAXES?
29. HOW MUCH IS OWED FOR RESTITUTION?
30. WHICH STATE?
31. Liens & Levies

Tax entity has filed liens on your property No tax liens have been filed Taxpayer owns no property of value Taxpayer owns real estate There is a tax levy currently in effect There are no levies in effect
32. Are you currently being audited?

Yes No.
33. Have you been audited in the past?

Yes No
34. Are there any unfiled IRS tax returns? If yes, what tax years are missing returns.
35. Are there any unfiled state tax returns? If yes, what years?
36. Have you at any time:

Filed or been accused of filing a fraudulent tax return Attempted or been accused of tax evasion Charged with or been accused of any other tax crime Lied to any tax collector Assaulted or attempted to assault a tax officer Tried to hide assets Transferred title to anything to a minor? Transferred title to a spouse, friend, business associate, family member Deposited money in a friend's, associate's, or family member's bank account Deposited money in an off-shore bank account Forged any tax or financial documents Filed a lien against a tax officer Deposited property or money into a trust Deposited property or money into a close corporation Purchased property in someone else's name Lost, concealed, or destroyed financial records Sold or traded valuable assets for less than fair value Lived a "lavish lifestyle" while owing back taxes Changed banks frequently to avoid levies Changed your name, social security number, or similar documents Been a member of a tax protest organization
37. For which tax years or periods do you owe? Identify
38. Why did you not pay taxes?

Health problems Unemployment Tax Protester Losses due to fire, theft, or other similar events Business failure Other reasons
39. Explain other reasons for not paying taxes
40. Why did you fail to file one or more returns?
41. Do you presently have a court hearing or a tax collection hearing coming up? If so, when is it calendared for?
42. Have you been notified or served with a tax action that you must reply or respond to?

NO Yes - criminal charges - fraud or evasion Yes - Notice of Deficiency Yes - reply to audit Yes - IRS claim in bankruptcy Other pending matter
42a Deadline to reply or file:
43. Has the tax collector seized or is holding any of your money or property? Describe:
44. Are there other issues that King should know about?
45. Do you have a question?
PLEASE DOWNLOAD AND SIGN THE ATTACHED IRS FORM ON THE THANK YOU PAGE (after you hit "SUBMIT" below
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