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	Preliminary Interview If you are ready to discuss your tax resolution case, please fill out the form below. (Bold Fields are Required)                   First Name: * Required Last Name: * Required Address:   City:   State: Please Select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * Required Zip Code: * Invalid Zip Code Phone: (xxx) xxx-xxxx * Required * Invalid Phone Format E-Mail Address: * Required * Invalid E-mail Address How Would you Like to be Contacted? Phone Email * Required How Much do you Owe? Please Select Less than $30,000 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and 99,999 >$100,000 Does Not Apply to Me   Reason for Resolution: Please Select Business Tax Issues Currently Being Audited Disputing a Charge Innocent Spouse Liens and Levies Need a Penalty Abatement Need Current Year Tax Filing Need Prior Year(s) Tax Filings Other Owe Money and Cannot Pay Revenue Officer Contacted Me Seizure of Property Wage Garnishment   Employment Status: Please Select Employed Full-Time Employed Part-Time Other Retired Self-Employed Unemployed * Required Schedule Appointment Now? Yes No * Required Additional Comments:       Enter Characters Shown Above:
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