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Personal Questionnaire

Personal Tax Problem

    Personal Information

     

    Salutation:

    First Name:

    Last Name:

    Email:

    Business Title:

    Mailing Address:

    Suite or Apartment:

    City:

    State:

    Zip code:

    Home Telephone:

    Cellular Telephone:

    Telefax:

    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'"]

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