Please complete this form with accurate and up-to-date information for both the taxpayer and spouse, if applicable. All fields are required unless otherwise noted. If you have any questions, feel free to contact us for assistance. By submitting this form, you consent to the use of the provided information for tax resolution purposes.

Por favor, rellene este formulario con información exacta y actualizada tanto del contribuyente como de su esposo/a, si es aplicable. Todos los campos son obligatorios a menos que se indique lo contrario. Si tiene alguna pregunta, no dude en ponerse en contacto con nosotros. Al enviar este formulario, da su consentimiento para el uso de la información proporcionada con fines de resolución fiscal.

CLIENT INFORMATION

(Información del Cliente)

Taxpayer Full Name *

(Nombre Completo del Contribuyente)

First Name

Last Name

Taxpayer Date of Birth *

(Fecha de Nacimiento del Contribuyente)

YYYY

Taxpayer Social Security Number

(Número de Seguro Social del Contribuyente)

Taxpayer ITIN

(Número ITIN del Contribuyente)

Taxpayer Phone Number *

(Número de Teléfono del Contribuyente)

Country

(###)

###

####

Do you consent to receiving text messages regarding your case? *

(¿Autoriza recibir mensajes de texto sobre su caso?)

Yes (Sí)

No (No)

Taxpayer Email Address *

(Correo Electrónico del Contribuyente)

Spouse Full Name

(Nombre Completo del Cónyuge)

First Name

Last Name

Spouse Date of Birth

(Fecha de Nacimiento del Cónyuge)

YYYY

Spouse's Social Security Number

(Número de Seguro Social del Cónyuge)

Spouse ITIN

(Número ITIN del Cónyuge)

Spouse Phone Number

(Número de Teléfono del Cónyuge)

Country

(###)

###

####

Do you consent to receiving text messages regarding your case? *

(¿Autoriza recibir mensajes de texto sobre su caso?)

Yes (Sí)

No (No)

Spouse Email Address

(Correo Electrónico del Cónyuge)

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Language *

(Idioma Preferido)

English (Inglés)

Spanish (Español)

Other (Otro)

EMPLOYMENT & INCOME INFORMATION

(Información de Empleo e Ingresos)

Taxpayer Occupation *

(Ocupación del Contribuyente)

Taxpayer Employer Name

(Nombre del Empleador del Contribuyente)

Is the taxpayer self-employed? *

(¿El contribuyente trabaja por cuenta propia?)

Yes (Sí)

No (No)

Spouse Occupation

(Ocupación del Cónyuge)

Spouse Employer Name

(Nombre del Empleador del Cónyuge)

Is the spouse self-employed?

(¿El cónyuge trabaja por cuenta propia?)

Yes (Sí)

No (No)

TAX INFORMATION

(Información Fiscal)

Tax Year(s) Involved *

Año(s) fiscal(es) implicado(s)

Type of Tax Issue *

(Tipo de Problema Fiscal)

Has the IRS contacted you? *

(¿El IRS se ha comunicado con usted?)

Yes (Sí)

No (No)

IRS Letter or Notice Number

(Número de Carta o Notificación del IRS)

Estimated Amount Owed

(Monto Estimado a Pagar)

PAYMENT & FINANCIAL INFORMATION

(Información de Pago y Finanzas)

Do you currently have an installment agreement with the IRS? *

(¿Tiene un acuerdo de pago con el IRS actualmente?)

Yes (Sí)

No (No)

Monthly Payment Amount

(Monto del Pago Mensual)

Do you have other tax debt (state/local)? *

(¿Tiene otras deudas fiscales [estatal/local]?)

Yes (Sí)

No (No)

Are you currently in bankruptcy? *

(¿Está en bancarrota actualmente?)

Yes (Sí)

No (No)

ADDITIONAL INFORMATION

(Información Adicional)

Do you have any other relevant information or documents?

(¿Tiene información o documentos adicionales relevantes?)

Thank you for submitting your information! Your form has been successfully received. We will review your details and reach out to you shortly to discuss the next steps in your tax resolution case. If you have any immediate questions or concerns, feel free to contact us.

Gracias por enviar su información. Su formulario ha sido recibido con éxito. Revisaremos sus detalles y nos pondremos en contacto con usted en breve para discutir los próximos pasos en su caso de resolución de impuestos. Si tiene alguna pregunta o preocupación inmediata, no dude en ponerse en contacto con nosotros.

The information provided on this website is for general informational purposes only and should not be construed as legal advice or a substitute for consultation with an attorney. Viewing this website or contacting HMA Law does not create an attorney-client relationship. While we make every effort to ensure the accuracy and timeliness of the information presented, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability, or availability with respect to the website or the information, products, services, or related graphics contained on the website for any purpose. Any reliance you place on such information is strictly at your own risk.

In no event will HMA Law be liable for any loss or damage including, without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from loss of data or profits arising out of, or in connection with, the use of this website.

Through this website, you may be able to link to other websites that are not under the control of HMA Law. We have no control over the nature, content, and availability of those sites. The inclusion of any links does not necessarily imply a recommendation or endorse the views expressed within them.

Every case is unique, and the outcome of your legal matter may vary depending on the specific facts and circumstances. Prior results do not guarantee a similar outcome. Therefore, if you require legal advice or representation, we encourage you to contact us to schedule a consultation with one of our attorneys.

You belong here. ♡

Blessed are the peacemakers, for they shall be called children of God.
Matthew 5:9