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Personal Questionnaire

Personal Tax Problem

Personal Information



First Name:

Last Name:


Business Title:

Mailing Address:

Suite or Apartment:



Zip code:

Home Telephone:

Cellular Telephone:


Type of tax owed: [dynamicselect tax-debt-type include_blank "Unfilled Personal" "Unpaid Business" "Unpaid Payroll" "Taxes assessed by IRS" "Other" "CF7_POST key='OWEUX_TAX_DEBT_TYPE'" ]

What years are Involved:

Approximate Amount:

The best time to contact:

Please contact me by:

I have been audited

I have been levied through My bank AccountI have been levied through My Payroll Earnings

I have not filed my tax returns

I have not received notices of levies and/or lien

Additional Information

[dynamictextarea additional-information "CF7_POST key='OWEUX_ADDITIONAL_INFORMATION'"]