Taxation Case Evaluation Form

*Name:

*Address:

*City:

*State:
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*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Are you known by any other names?
Yes  No 

If yes, list other names you have used:

What is your marital status?
Choose One Single Married Divorced Separated Widowed

Does this matter involve a business you own or run?
Yes  No 

If yes, provide the business name, address, and phone:

If a business is involved, how is the business organized (if known)?
Choose One Sole Proprietorship Partnership Limited Liability Company or Partnership Professional Corporation S Corporation C Corporation Other

What is the principal type of taxation involved in your situation?
Choose One Income Tax-Federal Income Tax-State Property Tax Other

Describe your situation, including any relevant dates:

Have you been in contact with any governmental agency or official regarding this matter?
Yes  No 

If yes, please provide the name and address of the agency or official:

Have any civil or criminal proceedings been started regarding this matter?
Yes  No 

If yes, please set out the type of proceedings, the court in which the action is brought, and the date commenced:

How would you rate your legal needs described here?
Choose One Extremely Urgent Urgent Standard Informational Only

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

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