LAW OFFICES OF MORGAN D. KING

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

STEP # 3 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. 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. Hit "Submit" below to proceed to IRS Form 8821: Not applicable Ok Other This online form was provided by Freedback.