Tax Debt Resolution Intake form

First Name *

Last Name *

Phone Number *

Email *

Are you Single or Married? *

If married, do you file Jointly or Separately? *

How much do you think you owe? (Federal) *

How much do you think you owe? (State) *

Are you currently employed? *

How much do you make a year? *

Do you have any dependents? *

Are you currently on any payment plans with the IRS? *

Do you have any retirement accounts? *

Do you have any life insurance plans that hold monetary value? *

Do you have any Virtual Currency? (Bitcoin, Litecoin, Ethereum etc.) *

Do you own or rent any properties? *

How many vehicles are registered in your name? *

Are you in bankruptcy? *

Have you experienced any hardships in the last 5 years? (Deaths, loss of income, illnesses etc.) *

How did you get in this situation?

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