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LAW OFFICES OF MORGAN D. KING CONFIDENTIAL TAX HISTORY FORM # 1 This form contains 50 short questions that will help Mr. King get an instant snapshot of your situation. Fill out this form and hit "SUBMIT FORM" button at bottom of form. NOTE: Items marked with an asterisk* are required.

*1. DATE: *2. TAXPAYER'S NAME: *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 *5. Is Taxpayer presently scheduled for a hearing before the taxing entity? YES NO HEARING IS EXPECTED TO BE SCHEDULED SOON *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: 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. Were tax returns filed for all years for which IRS taxes are owed? NOT APPLICABLE UNKNOWN YES NO NOT SURE 44. Check all years for which IRS tax returns have not been filed: 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 *45. 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 46. Were tax returns filed for all years for which STATE taxes are owed? YES NO NOT SURE 47. Check all year for which state tax returns have not been filed: 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. 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 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 evasion Taxpayer convicted/pled guilty to criminal fraud or evasion Fraud penalties have been assessed One or more prior offers-in-compromise filed 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 *49. At any time in the last 10 years has the taxpayer or spouse: [check those that apply - to best of memory] 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 Hidden 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 offshore bank account Claim incorrect number of exemptions on a tax return Lose, conceal, or destroy financial documents Maintain a "lavish" lifestyle while not paying taxes Conceal income by paying a spouse, other family member, or close associate a disproportionate salary and play yourself an unusually low salary 50. Taxpayer - Provide information or explain any item checked above or anything else that may raise questions regarding your tax history create web form