Name Spouse Name Address Address 2 City, ST. Zip Phone 1 Phone 2 Phone 3 Email Best Contact Method
I.R.S. Liability Information

Total # of Persons in your Household (Including you and your spouse (Required)

Amount Owed to I.R.S.

Monthly Household Income

I owe income taxes (1040)

I owe payroll taxes (941)

I owe self-employment taxes (1099 / Sched. C)

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I have unfiled or open returns

A tax lien has been filed

I am self-employed or own a business

I am under IRS audit or investigation

There is a current or intended levy by the IRS
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