How can we best get in touch with you
Street Address Line 2
State / Province
Postal / Zip Code
Best days/times to call
Current Tax Sitation
Please thoroughly complete the following questions. If an item does not apply simply mark "NO" or "N/A".
Amount Owed to IRS
Tax Types Owed
Personal Income Tax
Trust Fund Recovery Penalty
Business Income Taxes
Do you currently have a Revenue Officer (IRS field agent) assigned to you? If so, what are the most recent actions they have taken against you or requests they have made?
Do you have any current deadlines for information or payments that you need to meet?
What was the date and title of your last letter received from the IRS?
Have there been any IRS threats of levies, wage garnishments, or seizures?
Have you paid your current Federal Tax Deposits or Estimated Tax Payments on time and in full?
Do you have any past due, unfiled tax returns? If yes, what years (or quarters) and tax forms have not been filed?
Do you have any existing written or verbal agreements with the IRS, including delays or extensions of collection action or agreements to make “Good Faith Payments” on a regular basis?
Have there been any recent bank account levies, seizures, wage garnishments, or other aggressive collections action? If so, when and what action was taken?
Please describe, in your own words, the circumstances that gave rise to your back tax liability
Please describe any actions you or a representative have taken recently to address your tax matters
Do you have any currently filed IRS Appeals in progress? If so, what is their status
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