Prospective Client Online Application

Please note that you do not automatically become a client by 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.​
First Name:
Last Name:
Date of Birth:
Select a date from the calendar.
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   IncomeSource 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?:
If Yes, what type and where?:
Do you own a small business?:
Does anyone else living in your home receive income?:
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.