FORM # 4a
CONFIDENTIAL
TAX PROBLEM
STATUS & HISTORY
Date
-
Month
-
Day
Year
Date
1. Who is filling out this form?
Morgan King
A King Law Firm Associate
Taxpayer's enrolled agent or CPA
A TaxPayer who owes back taxes
Taxpayer's spouse or other relative
Taxpayer's Attorney
Other
Other person filling out this form: Please include name and phone number.
1a.Name of associate of Morgan King's tax practice who is referring this case:
Rattan Dhaliwal
Other professional
Not applicable
If "Other Professional " please provide name and phone number:
1b. Taxpayer or his/her tax professional has these tax-related documents available:
I have IRS 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.
I have no tax-related documents
Other important documents:
2. Taxpayer's Name including middle initial:
*
First Name
Last Name
3. Taxpayer's Current Marital status
Single - never married
Married and living together
Married but living apart
Divorced
Formerly married - spouse deceased
Formerly married - other
4. Current Spouse's name
First Name
Last Name
5. Taxpayer's current E-mail Address
6. Taxpayer's preferred Phone Number:
-
Area Code
Phone Number
7a. Taxpayer prefers that our first contact be with:
Himself
Spouse
Taxpayer's current tax professional
The tax collector directly
Other:
7b. Preferred way to Contact the taxpayer?
*
E-mail
Phone
Personal meeting
Texting
U.S. Post
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 currently represented by:
Morgan King
Other Attorney to be retained
Accountant
Enrolled agent
Other Tax help person
No one at present
12a IF OTHER, PLEASE IDENTIFY
13. If attorney or other tax professional has been, or is being dismissed or relieved of taxpayer's representation 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 (if any)
16. ENROLLED AGENT'S I.D.
17. Upload documents relevant to taxpayer's problem (Max 35 pages)
Browse Files
Cancel
of
18. Has taxpayer filed bankruptcy within the last 10 years?
Filed Chapter 7 bankruptcy and finished it
Filed Chapter 7 and still in Chapter 7 bankruptcy
Never filed bankruptcy
Thinking about filing bankruptcy
Filed Chapter 13 and finished it
Filed Chapter 13 and still in it
Filed Chapter 11
19. Have you at any time:
1. Filed an IRS "CDP" - IRS Collection Due Process appeal
2. Applied for an installment payment plan with a tax collector
3. Applied for an offer-in-Compromise with a tax collector
4. Litigated a tax issue in any Tax Court
5. Been audited by the IRS and / or assessed additional taxes, or been audited or assessed by a state tax collector
6. Been in official "non-collectible status"
7. Failed to file one or more tax returns
8. Filed one or more tax returns late
9. Appealed anything to a higher tax collector's office or tax court
10. Been ruled an "innocent spouse"?
11. Been charged with tax fraud or tax evasion?
12. Plead to or been found guilty of tax fraud or evasion?
13. Been given a Military deferment?
14. Agreed to an extension of the statute of limitations with the tax collector?
15. None of the above
20. What kind of taxes do you owe that are over 3 years old, or that a tax collector claims you owe that are over 3 years old?
IRS personal income taxes
IRS payroll trust-fund taxes
State personal income taxes
State payroll trust-fund taxes
Sales taxes
IRS tax penalties
State tax penalties
Other taxes
Restitution for delinquent taxes
21. HOW MUCH IS OWED FOR IRS INCOME TAXES?
22. HOW MUCH IS OWED FOR IRS PAYROLL TAXES?
23. HOW MUCH IS OWED FOR STATE INCOME TAXES?
24. FOR WHICH STATE ARE THE STATE TAXES OWED?
25. HOW MUCH IS OWED FOR STATE PAYROLL TAXES?
26. HOW MUCH IS OWED FOR STATE TAX PENALTIES?
27. HOW MUCH IS OWED FOR STATE SALES TAXES?
28. HOW MUCH IS OWED FOR IRS PENALTIES?
29. HOW MUCH IS OWED FOR OTHER TAXES?
30. HOW MUCH IS OWED FOR RESTITUTION?
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
NONE OF THE ABOVE
37. For which tax years or periods do you owe? Identify, and list how much is owed for each year.
38. Why did you not pay or were unable to pay these 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
41. Do you presently have a court hearing or a tax collection hearing coming up? If so, when is it calendared for?
40. Why did you fail to file one or more returns?
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. For the years you owe taxes, did you file all the required tax returns and reports MORE THAN 2 YEARS AGO?
YES
NO
UNCERTAIN
44. Are there other issues that King should know about?
45. Do you have a question?
Enter the message as it's shown
*
48. WERE ALL OF YOUR TAX RETURNS HONEST AND COMPLETE?
YES
NO
UNCERTAIN
49. WERE ALL OF THE TAXES ASSESSED MORE THAN 240 DAYS AGO?
YES
Type option 2
Type option 3
Type option 4
50. HAVE YOU TRIED TO ILLEGALLY EVADE REPORTING OR PAYING YOUR TAXES?
51. VALUE OF EQUITY IN RESIDENTIAL REAL PROPERTY:
52. VALUE OF EQUITY IN FINANCIAL ASSETS (annuities, stocks, pensions, etc.)
51. VALUE OF PERSONAL ITEMS OF VALUE (antiques, collections, etc.)
52. VALUE OF ANYTHING ELSE OF VALUE:
53. DOES ANYONE OWE YOU ANYTHING, OR IS HOLDING SOMETHING OF VALUE IN THEIR NAME:
54. ANY REFUNDS EXPECTED? (e.g. tax refunds)
55. VALUE OF EQUITY IN COMMERCIAL REAL PROPERTY
56. BELOW: First, click "PRINT FORM" to print this questionnair for your records.
57. THEN get IRS Form 8821 "Tax Information Authrization" by hitting IRS form titled "Form 8821" will come up. DOWNLOAD AND SIGN IRS FORM
Submit
Print Form
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