Offer in Compromise Tax Lien Tax Levy Wage Garnishment Tax Filing

Please fill out the following form to the best of your ability. This will help us better develop a solution to your IRS problem.

Name
Daytime Phone no. Evening Phone no.
Email address

Street Address
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Preferrable way of contact: Email Phone

Best time to contact

Is the IRS garnishing your wages? Yes No	Has the IRS recently levied your bank account(s)? Yes No
Are you currently going through a bankruptcy? Yes No	Are you currently under IRS audit examination? Yes No
Do you have any unfiled tax returns? Yes No Unsure	Total amount of tax liability:
You are: Single Married Divorced/Seperated Widowed	Is your spouse assessed with the tax liability? Yes No Unsure
The liability is in: Your name The name of your business Both Someone you know	What is your net monthly income, after deductions and taxes? ( An estimate is fine)
What is your spouse's net monthly income, after deductions and taxes? ( An estimate is fine)	How many people are in your household?

How old are you?	Do you have a major health problem? Yes No
Is anyone depended on you having a major health problem? Yes No	Outline the health problem:
Do you or your spouse own a real estate? If yes: What is the Fair Market Value? The amount of unpaid mortgage?	Do you or your spouse own any retirement plan such as an IRA or 401(k)? If yes: What is the total amount? Amount borrowed against 401(k), if applicable?
Do you have a tax lien? Yes No Are you interested in removing the lien to buy or refinance realestate? Yes No	Did you use a search engine to find us? If yes: Search engine used: Search term used:

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