Confidential Claim Evaluation
Form ---Complete the form or call us today at 1-800-254-0199
to set up a confidential no obligation telephone conference
with an attorney.
First Name:
Last Name:
Address:
City:
State:
Zip:
County:
Home Phone:
Business Phone:
E-mail:
State the names and addresses of all individuals, accounting firms, law firms, and others who participated in the transaction in any way. Please include anyone who promoted, solicited, recommended the transaction or provided any legal, accounting, or other service related to the transaction.
A
Name:
B
Name:
C
Name:
What is the total amount that you paid in fees for the tax shelter or arrangement? Include fees based on tax savings, operational fees, legal fees, annual implementation fees, trustee expenses, etc.
$
What is the total amount of tax savings that the shelter was supposed to provide?
$
Identify each taxable year (including prior carryback taxable years) for which the transaction is expected to have the effect of reducing your federal income tax liability, and estimate the amount by which the transaction is expected to reduce your federal income tax liability for each such taxable year.
Taxable Year:
Taxable Year:
Taxable Year:
Have you been contacted by the IRS with regard to the transaction? Explain the status of any IRS audit or inquiry
Have you participated in any "amnesty programs" or other transactions wherein you later paid tax, interest or penalties because you previously participated in the shelter? If yes, state amount paid and explain.
Additional questions or comments:
