Application for Services
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Current Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
Best hours to contact you
ex: after 3pm or between 1 and 4pm
E-mail
*
Sex
*
Female
Male
Prefer not to say
First language
*
Are you currently married?
*
Yes
No
Spouse Name
*
First Name
Last Name
My spouse lives at the same address as I do.
Spouse Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse Phone Number
-
Area Code
Phone Number
Spouse Email
example@example.com
Annual income (add spouse's income if married)
*
How many people in your household (related by blood, marriage, or adoption)?
*
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
Docket Number
example: 52637-19S
Have You Ever Filed For Bankruptcy?
*
Yes, and I have an active bankruptcy case pending in court right now.
Yes, a long time ago.
No.
I'm not sure.
How can we help you?
0/1400
If you have a letter from the IRS or other document upload it here. (Optional)
Browse Files
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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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