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LAW OFFICES OF MORGAN D. KING

Attorney & Counselor at Law

CONSULTING FOR TAX TRANSCRIPT ANALYSIS | BANKRUPTCY DISCHARGE | OFFER-IN-COMPROMISE | INNOCENT SPOUSE | INSTALLMENT PLAN | COLLECTION APEALS | | TRANSMUTATION AGREEMENTS | & MORE
FORM # 4

CONFIDENTIAL TAX HISTORY FORM

This form contains 60 questions that will help Mr. King get an instant snapshot of your situation.

Answer the following as best you can and hit "SUBMIT FORM" button at bottom of form.

NOTE: Items marked with an asterisk* are required.

CONFIDENTIALITY NOTICE: This e-mail transmission, and any documents, files or previous e-mail messages attached to it, may contain confidential information that is legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of any of the information contained in or attached to this message is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify us by reply e-mail at morgan@morganking.com or by telephone at 925 829-6363, and destroy the original transmission and its attachments without reading them or saving them to disk. Thank you. This email is covered by the Electronic Communications Privacy Act, 18 U.S.C. §§ 2510-2521 and is legally privileged. This information is confidential information and is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. IRS Circular 230 Disclosure: To ensure compliance with requirements imposed by the IRS, we inform you that any U.S. federal tax advice contained in this communication (including any attachments) is not intended or written to be used, and cannot be used, for the purpose of (i) avoiding penalties under the Internal Revenue Code or (ii) promoting, marketing or recommending to another party any transaction or matter addressed herein.

*1. Date:

*2a. TAXPAYER'S NAME:

2b. PLEASE ENTER TAXPAYER'S SOCIAL SECURITY NUMBER (confidential submission)

PLEASE ENTER THE SSN AGAIN TO VERIFY

2c. WHO IS FILLING OUT THIS FORM?

Taxpayer
Taxpayer spouse
Taxpayer tax professional
Taxpayer other attorney
Other

*3. URGENCY LEVEL

NOT APPLICABLE:
URGENT: Need immediate professional intervention
CONCERNED: May need professional help soon
NEED A CONSULTATION ONLY: Seeking ways to resolve delinquent tax issues before tax collection activity commences

*4. If URGENT the nature of the emergency is:

NOT APPLICABLE:
TAX LEVY IN EFFECT
TAX LEVY THREATENED
OTHER URGENT TAX COLLECTION PROBLEM
OTHER TAX-RELATED PROBLEM
URGENT BANKRUPTCY PROBLEM
NOTICE OF INTENT TO ASSESS WITHIN LAST 30 DAYS

*5. Is Taxpayer presently scheduled for a hearing before the taxing entity?

YES
NO
HEARING IS EXPECTED TO BE SCHEDULED SOON
MAYBE - I'M NOT SURE

*6. Taxpayer has recently received:

NOT APPLICABLE
URGENT Notice of Intent to Levy
FINAL Notice of Intent to Levy
A NOTICE OF LEVY
NOTICE OF UNCERTAIN TYPE

7. If a FINAL Notice of Intent to Levy has been received - DATE of the notice is:

*8. Is the TAXPAYER being referred to Morgan King's office by another tax professional?

YES
NO
UNCERTAIN

9. If referred by someone - Referrer's status:

Attorney
Enrolled agent
CPA
Accountant
Bookkeeper
Former client of Morgan King's
A friend or acquaintance
Government employee
Other
Unknown

*10. If not referred by someone - how did Taxpayer find Mr. King's services:

Can't recall
Internet search & found MorganKing.com
Internet search & found TaxJustice.com
Read about Mr. King in a publication
Read an article by Mr. King in a periodical
Heard Mr. King speak on this topic
Heard a radio or television advertisement for Morgan King
Saw his ad in a newspaper or periodical publication
Direct mail letter or brochure from Mr. King
An e-mail newsletter or message from Mr. King
Other

11. PERSON WHO REFERRED TAXPAYER TO MORGAN KING: Referring person's name (if any)

12. Referrer's office phone no.

13. Referrer's Email address:

14. Referrer's fax no.

15. Referrer or Taxpayer has the following tax transcripts in his/her possession:

NO tax transcripts in his/her possession
IRS Account Transcripts for tax years/periods in question
IRS IMF Specific Transcripts for tax years/ periods in question
IRS TXMOD transcripts for tax years/periods in question
Other IRS tax transcripts for tax years/periods in question
State tax transcripts for tax years/periods in question

16. Does Referrer request that Mr. King's office obtain the required transcripts?

NOT APPLICABLE
YES
NO
Consult first

17. The information provided by the referrer on this form is based on:

NOT APPLICABLE
Brief consultation with taxpayer
Lengthy consultation with taxpayer
Conference with tax entity agent
Conference with taxpayer's other tax professional
Review of documents provided by taxpayer
Review of documents provided by FOIA request
Tax Transcripts
Other

18. Comments from REFERRER regarding this matter:

*19. TAXPAYER PROFILE: TAXPAYER'S FULL NAME:

19a. What is taxpayer's birth date?

20. Taxpayer resides in what city and state?

*21. Taxpayer's best phone number for contact by Mr. King's office:

22. Taxpayer's evening phone no:

23. Taxpayer's day phone no.

24. Taxpayer's Email Address:

25. Taxpayer's fax no.

*26. Taxpayer's marital status:

NOT APPLICABLE
Married and living together
Married - living apart
Currently Divorced
Never married
Widowed

27. If currently married or divorced - date of marriage:

28. If divorced or widowed - date of final decree or death of spouse:

29. If currently married - name of spouse used on tax returns:

30. If currently married:

We file jointly
We file separately

31. Is Taxpayer's current or former spouse also liable for some or all of Taxpayer's delinquent taxes?

NOT APPLICABLE
YES
NO

32. Taxpayer's principal occupation is:

Wage earner
Self-employed as a sole proprietor
Self-employed as a corporation
Self-employed as a partnership
Retired
Other

*33. Is taxpayer currently in bankruptcy?

YES
NO

*34. Is taxpayer planning to file bankruptcy?

YES
NO

35. If YES, which chapter of bankruptcy?

NOT APPLICABLE
UNKNOWN
Chapter 7
Chapter 13
Chapter 11

*36. Has taxpayer filed prior bankruptcy within the last 10 years?

YES
NO

*37. If YES - what chapter did he/she file?

NOT APPLICABLE
UNKNOWN
Chapter 7
Chapter 13
Chapter 11

38. Did Taxpayer file more than one bankruptcy in the past?

YES
NO

*39. TAX INFORMATION: Est. total amount of all state and federal delinquent taxes owed:

40. Est. total amount of all other debts owed personally by the taxpayer (including mortgage, installment payments, credit cards etc.)

*41. Categories of taxes owed:

NOT APPLICABLE
UNKNOWN
IRS personal income taxes
IRS trust-fund (payroll) taxes
Other IRS taxes or penalties
State personal income taxes
State trust-fund (payroll) taxes
State sales or use taxes
Property taxes
Other taxes

*42. All years for which IRS taxes are owed:

NONE
UNKNOWN
Taxes owed before 1990
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

43. Are you now, or have you ever been a partner or shareholder in any kind of partnership or joint venture?

YES
NO

44. Have you been involved in any kind of voint venture or partnership that may incur personal tax liabilities?

YES
NO
MAYBE - I'M NOT CERTAIN

*45. Were tax returns filed for all years for which IRS taxes are owed?

NOT APPLICABLE
UNKNOWN
YES
NO
MAYBE - I'M NOT SURE

46. Check all years for which IRS tax returns have not been filed:

NONE. All required federal tax returns have been filed for the last 20 years
UNKNOWN
Before 1990
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

*47. All years for which STATE taxes are owed:

NONE
UNKNOWN
Taxes owed before 1990
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

48. Were tax returns filed for all years for which STATE taxes are owed?

YES
NO
MAYBE - I'M NOT SURE

49. Check all year for which state tax returns have not been filed:

NONE. All required state tax returns have been filed for the last 20 years
Before 1990
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

50. DO YOU OWN ANY KIND OF REAL ESTATE THAT IS CURRENTLY IN FORECLOSURE?

YES
NO

51. HAVE YOU HAD A HOME, COMMERCIAL PROPERTY, OR OTHER REAL ESTATE FORECLOSED IN THE LAST 5 YEARS?

YES
NO

*52. Check all the below events that have occurred in the Taxpayer's tax history - both state and federal - to best of memory.

NOT APPLICABLE
ALL UNKNOWN
Substitute for returns have been filed
Additional taxes have been assessed
Tax entity intends to assess additional taxes soon
Prior offer-in-compromise was accepted
Prior litigation in Tax Court or U.S. District Court
Taxpayer accused of tax civil fraud or tax evasion
Taxpayer charged with failure to file tax returns
Taxpayer convicted/pled guilty to civil fraud or evasion
Taxpayer accused of tax criminal fraud or tax evasioon
Taxpayer convicted/pled guilty to criminal fraud or evasion
Fraud penalties have been assessed
I submitted one or more prior offers-in-compromise within the last 10 years
I submitted an offer-in-compromise that is still being considered
Taxpayer has been or is currently a "tax protester"
Prior Collection Due Process hearing requested
Prior "equivalent" hearing requested
Prior Collection Appeal filed
Taxpayer is currently being levied
Taxpayer has been levied in the past
Taxpayer is currently being audited
Taxpayer has been audited in the past
Taxpayer has been in an installment payment plan
Taxpayer's prior installment plan was completed
Taxpayer's prior installment plan defaulted
Taxpayer is currently in an installment payment plan
Tax liens have been filed in Taxpayer's county of residence
Taxpayer's business has been "locked up" by IRS

53. Taxpayer is, or has been in the last 15 years, a partner, officer, board member, or shareholder in any partnership, LLC, corporation, or investment.

YES
NO
UNCERTAIN

54. If the answer to above is "YES": Is that entity currently being, or has been, audited, examined, or investigated by the IRS or state taxing agency?

NOT APPLICABLE
YES
NO
MAYBE

55. If the answer to above is "YES" please provide name of the entity and taxpayer's involvement:

*56. At any time in the last 10 years has the taxpayer or spouse: [check those that apply - to best of memor]

NOT APPLICABLE
ALL UNKNOWN
Been a tax protester
Created a trust and transferred property or assets to the trust
Created a trust as a strategy to avoid paying income taxes
Created a trust for any reason
Created a corporation and transferred property or assets to the corporation
Given away or transferred any asset worth more than $1,000
Given any minor-child a gift worth more than $5,000
Sold any assets for way below fair market value
Traded any asset worth more than $1,000
Transferred title to real property for less than fair market value
Purchased any asset in someone else's name
Deposited money in someone else's bank account
Frequently changed bank accounts
Closed any bank accounts
Hid or concealed any asset
Knowingly provided false information on a tax return
Transferred assets to a spouse or former spouse in a marital property agreement
Signed a postnuptial or transmutation agreement with spouse or former spouse
Added another's name to one of your bank accounts
Deposited personal income into your corporate bank account
Use or used an off-shore bank account
Claim incorrect number of exemptions on a tax return
Lost, concealed, or destroyed financial documents
Maintained a "lavish" lifestyle while not paying taxes
Conceal income by paying a spouse, other family member, or Paid a disproportionate salary to an employee and paid yourself an unusually low salary

57. Taxpayer - Provide information or explain any item checked above or anything else that may raise questions regarding your tax history

58. Personal property. Please checkoff any property or interests in property that you or your current spouse currently own, or have owned in the last 2 years other than business assets.

No property or assets of more than nominal value
Real property - residence
Real property - rental or commercial
Time-share
Other real property in which you own an interest or your name is on title
Trailer or mobile home residence
Private pension or retirement account
IRA of any kind
Public employee pension or retirement account
Other securities (stocks, stock options, bonds, CDs, etc)
Other investments
Motor vehicles and motorcycles worth more than $10,000
Boat
Aircraft
Other means of transportation
Antiques or art worth more than $5,000
Gems or jewelry worth more than $10,000
Hobbies or collections worth more than $10,000
Pets or animals (horses, etc.) worth more than $5,000
A trust of any kind
Money owed to you of more than $5,000
Loans you made to your corporation
Household furniture or furnishings worth more than $5,000
Bank checking or savings accounts holding more than $5,000
Cash on hand of more than $2,000
A lawsuit pending in which you may be awarded money
Inheritance currently pending
Checks, cashier's checks, money orders, or other notes made out payable to you of more than $5,000
Interest or stock in a closely held corporation
Expecting a tax refund
Expecting other public entity cash payment
Expecting marital property division assets from recent divorce or separation
Expecting an insurance payoff of any kind
Winning lotto ticket
Unusually valuable clothing
Sports equipment (fishing, hunting, scuba diving etc.)
Copyrights, patents, trademarks, or other intellectual property
Deposits (school, rental or lease, etc.)
Deposits or retainer fees to any professional
Contract worth money
Home technology (computers, printers, scanners, fax machines, etc.) worth more than $5,000.
Burial plot
Other personal property worth more than $5,000.
Minor child or children or own real or personal property worth more than $5,000.
Spouse who owns separate property worth more than $10,000

59. Business property. Please check off any real or personal property of a business or investment nature, that you currently own or have an interest in, or that is owned by a business or investment that you own or have an interest in.

None
Real property
Motor vehicles, including trucks, sedans & motorcycles
Boats or aircraft
Motorized Machinery and equipment
Other tools, machines and equipment
Office technology (computers, printers, scanners, etc.)
Phone systems
Furniture and fixtures (including file cabinets, shelving, cash registers, desks, seating, shredders, etc.)
Accounts receivable
Operating bank account
Trust-fund (payroll) bank account
Other bank accounts
Stock in trade, inventory, etc.
Supplies
Patents, copyrights, trademarks, licenses, other intellectual property.
Proprietary computer software and applications
Internet domain names, URLs, and web sites
Cash on hand
Checks, cashier's checks, or money orders payable to the business
Leases, contracts, and permits of value
Pending insurance payoff
Cashable value of an insurance policy
Lawsuit in which the business may be awarded money
An interest in another business entity or investment
Customer lists
Other goodwill assets
Signage
Other business or investment related assets

60. Have you or your spouse, at any time within the last 10 years, received a cash windfall or other benefit from any of the following?

No.
Yes - inheritance
Yes - Sold stock options
Yes- Won the Lotto
Yes - Sold one or more parcels of real estate
Yes - Liquidated other capital gain
Yes - Cashed out a good investment
Yes - Received a cash verdict or settlement in a lawsuit
Yes - Had a large debt forgiven
Yes - Gambling or horse race winnings
Yes - Large cash gift
Yes - Marital property settlement
Yes - Other

61. FAILURE TO FILE RETURNS: If applicable, please explain the circumstances causing you to fail to file any tax returns in a timely manner:

62. FAILURE TO PAY TAXES: If applicable, please explain the circumstances causing you to fail to pay taxes that became due:

63. Hit "Submit" below to proceed to IRS Form 8821:

Not applicable
Ok
Other


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