Full Name
*
Address
Street Address
City
State
Country
Country
Postal code
Email Address
*
Phone Number
*
Social Security Number (optional but helpful)
Tax Year for Extension Request: – Number Field
Filing Status
Single
Married filing joint
Married filing separately
Head of household
Qualified widower
Do you owe taxes to the IRS, your state, or both? (Select One: IRS/State/Both)
IRS
State
Both
Total Estimated Amount Owed:
Tax Year(s) Involved:
Have you received any notices about the debt?
Yes
No
If yes, provide the type of notice:
Notice of Federal Tax Lien
Notice of Intent to Levy
Other (Specify):
Other
Have you received a Notice of Federal Tax Lien?
Yes
No
Do you own property or assets affected by the lien?
Yes
No
If yes, list the assets impacted:
Current Employment Status:
Monthly Income:
Monthly Expenses:
Do you have other outstanding debts?
Yes
No
If yes, briefly describe:
Have you previously entered into a payment plan with the IRS or state?
Yes
No
If yes, provide details:
Have you missed any tax filings for prior years?
Yes
No
If yes, specify the years:
Are you currently working with a tax professional on this matter?
Yes
No
Have you attempted to resolve the debt or lien on your own?
Yes
No
If yes, describe the steps you’ve taken:
Submit and Schedule Your Consultation