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* Items in bold are required.
* Items in Italics are recommended.
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First Name:
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Last Name:
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E-Mail Address:
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Amount you owe the IRS:
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Zip Code:
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Best Phone Number:
(include area code)
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2nd Best Phone Number:
(include area code)
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Other Phone Number:
(include area code)
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Best time to contact you:
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Best day to contact you:
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Do you have a wage garnishment?
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Do you have a bank levy?
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Do you have a revenue officer?
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Do you have unfiled tax returns?
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