First Name

Last Name

Phone *

Email *

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First Name

Last Name

Phone *

Email *

Have you filed all tax returns you are legally required to file? *

Have you received a bill from the IRS? *

Have you made all estimared payments required for the current year? (Note: You are required to pay estimated taxes for the current year if you owed more than $1000 to the IRS for taxes due.) *

If you are a business owner with employees, have you made all required federal tax deposits for the current quarter and the two preceding quarters?

Are you currently in an active bankruptcy? *

Do you have an open audit or outstanding innocent spouse claims? *

Do you legimately doubt you owe the debt? *

Enter information about your location, household and tax debt.

Postal code

State

Total members of household

Total members of household 65 years or older

Total IRS tax debt including penalties and interest (whole dollars)

$

What is the most recent tax year the IRS is trying to collect on?

Enter information about your assets (in whole dollars). Your equity is the value of your asset minus what you still owe on the asset.

Total bank balances - Checking, savings, money market, CDs, etc. *

$

Home market value - The amount you could sell the asset for today

$

Vehicle 1 equity - the value of your vehicle minus what you owe

$

Vehicle 2 equity - The value of your vehicle minus what you owe

$

Retirement account equity (401k, IRA, etc.) - The value minus any loan you may have using your retirement account as collateral

$

Other real property equity - Rental, business, land, timeshare, etc. The value of the property minus what you still owe.

$

Other real property equity - Rental, business, land, timeshare, etc. The value of the property minus what you still owe.

$

Other asset equity (airplane, motorcycle, recreational vehicles, etc.) - The value of the asset minus what you still owe

$

Stocks, bonds and other investments, etc.

$

Miscellaneous - Art, coin, and gun collections, etc.

$

Enter information about your household monthly income (in whole dollars). The entire household includes all those in addition to yourself who contribute money to pay expenses relating to the household such as rent, utilities, insurance, groceries, etc.

Gross wages including Social Security, pensions, unemployment, etc

$

Interest and dividends

$

Distributions from partnerships, sub-S corporations, etc. - Enter the total distributions from partnerships and subchaper S corporations reported on Schedule K-1

$

Net rental income - Enter monthly net rental income. This is the amount earned after ordinary and necessary monthly rental expenses are paid. Do not include deductions for depreciation or depletion. If the net rental income is a loss, enter "0." Do not enter a negative number

$

Net business income - Enter monthly net business income. This is the aamount earned after ordinary and necessary monthly business expenses are paid. If the net business income is a loss, enter "0." Do not enter a negative number

$

Child support received

$

Alimony received

$

Additional income - Include agricultural subsidies, unemployment compensation, gambling income, oil credits, rent subsidies, etc.

$

Enter information about your typical month’s household expenses (in whole dollars). Maximum allowances for expenses are determined based on your location and number of members of your household. We estimate and include expenses for your food, clothing, miscellaneous items and out of pocket medical expenses.

Rent or mortgage and utilities - Enter the monthly rent or mortgage payment for your principal residence. Add the average monthly expenses for property taxes and homeowner's insurance if not included in mortgage payment, renter's insurance, maintenance, dues, fees, utilities. Utilities include gas , electricity, water, fuel, oil, other fuels, trash collection, telephone, cell phone, cable television and internet services

$

Total vehicles owned - If you are single you are only allowed expenses for one vehicle.

$

Vehicle 1 loan or lease payment

$

Vehicle 2 loan or lease payment

$

Vehicle operating cost - Enter the average monthly costs for insurance, licenses, registration fess, inspections, normal repairs and maintenance, fuel, parking and tolls

$

Public transportation cost - bus, train, taxi fares, and any other mass transit fares

$

Health insurance premiums

$

Life insurance premiums

$

Federal, state, and local taxes - state and federal taxes withheld from salary or wages, or paid as estimated taxes. If applicable, include county, city, and municipal income taxes *

$

Court-ordered payments - child support, alimony, etc.

$

Child dependent care costs

$

Please upload any notices , copies of tax returns, etc.