*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