Prospective Client Online Application

Please note that you do not automatically become a client b​y submitting this form. After receiving your completed form, the LITC will contact you to set up an initial consultation meeting. After the consultation meeting, a clinician will inform you about your status.

Please bring copies of the following items (when applicable) to your first consultation:

• IRS 30-Day Letter
  
• Tax returns you filed for any year in controversy, supporting schedules that are part of the tax returns, W-2's, and other documentation relating to the tax returns
• Any correspondence to and from the IRS
  
• Any other notices recei​ved from the IRS.​
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  How did you hear about us? First Name: Last Name: Date of Birth: Date of Birth Date Address: Preferred Telephone: Alternate Telephone: Email: Tax years in question: Amount due to the IRS: Briefly describe your tax issue: How many people are in your household (related by blood, marriage, or adoption)?     Please tell us how much income you receive from the following sources. Type "N/A" if it does not apply to you.     : Type of   Income Source of Income   (Ex: Name of your Employer) Amount of income/Month (Ex: $878/month) Wages   Unemployment   Social   Security/Disability Self-   Employment Rental   Income Gambling   Winnings Dividends   Disability   Child   Support Alimony Received     Do you own any real estate?: Yes No If Yes, what type and where?: Do you own a small business?: Yes No Does anyone else living in your home receive income?: Yes No If   Yes, how much income do they receive?   Person 1 income:   Person 2 income:   Person 3 income:   I hereby affirm that the financial information I have provided The University of Michigan law School Low Income Taxpayer Clinic is correct.
  
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