Application for Services
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Best hours to contact you
ex: after 3pm or between 1 and 4pm
Current Address
Street Address
Street Address Line 2
City
Please Select
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State
Zip Code
E-mail
*
Social Security Number or ITIN
(if applying for ITIN and no number has been assigned yet, write 999-99-9999)
Gender
*
Female
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Prefer not to say
Relationship Status:
*
Single
Married
Divorced
Legally Separated
Widowed
Other
Preferred language
*
How many people in your household (size of family unit)?
*
Annual income (add spouse's income if married)
*
Received IRS letters?
Yes
No
Not sure
Tax Years in controversy
Amount in controversy
Do you have a U.S Tax Court date?
Yes
No
U.S Tax Court Date
-
Month
-
Day
Year
Date
How can we help you?
*
0/1400
For taxpayer's most recent tax return, choose all that are true:
*
I used a paid preparer to file my return.
My return was efiled.
I had to paper mail in my return.
I filed my tax return at KYCC.
I filed my tax return at a VITA site.
I did not file a tax return last year.
Other
I would like a consultation
*
In person at the KYCC office
Over the phone
If you have a letter from the IRS or other document upload it here. (Optional)
Browse Files
Cancel
of
Online Submission Acknowledgment
*
While KYCC exercises reasonable due diligence to keep your information secure and confidential, by clicking the submit button, you acknowledge that communications are not necessarily guaranteed to be secure or confidential, and that merely initiating contact with KYCC does not create an attorney–client relationship. You also acknowledge and permit KYCC to share your confidential information with trained volunteers who exercise the duty of confidentiality required in a professional relationship, if you become a clinic client.
No, I do not agree to the above statement. Please understand that we may not be able to take on your case, but you can still qualify for a consultation.
If someone else helped you complete this form, please write their name below.
Helper's relationship to you
ex. legal aid, social worker, friend, son etc.
Helper's Contact Information
ex. email, phone#
Do you give us permission to discuss your IRS issues with the above named person?
Yes
No
Please verify that you are human
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