Complete The Form Below Please Select The Type Of Entity*IndividualBusinessBothIt is not necessary to answer every question on the Official TaxSqueal Allegation Form. However, please attempt to complete as many fields as possible without guessing. If you cannot answer or choose not to answer a certain question(s), simply leave it blank. The * signifies a required field. Remember, the more specific the information provided, the greater the likelihood for further consideration by the proper taxing authorities.Name*FirstLastAddressStreet AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodeSocial Security # (If Available)Approximate Age or DOB Business Name*Business AddressStreet AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZip CodeEmployer ID (If Available)Type of BusinessSuspected Violation(s)*Unreported IncomeExcess WealthFalse ExemptionsCash WagesFailure To File Tax Return(s)Income From Illegal ActivityFalse DeductionsOtherUnreported Income20122011201020092008 Describe the details of the suspected violation* *Are the records/books available?*YesNoNot SureBanks used by this individual or business Assets of value How did you become aware of the information you provided?Is this individual dangerous?*YesNoNot SureTerms Of Use*I Agree To The Terms Of Use Optional TaxSqueal Features Anonymous Mail Notification - Elect to have a printed notification mailed directly to the alleged tax cheat, alerting them that an anonymous allegation was submitted and processed by TaxSqueal. There is a $2.00 charge for this service. TaxSqueal PLUS - TaxSqueal submissions are FREE. However, if you would like to enhance your allegation submisson so as to garner maximum interest from investigative agencies you may consider the TaxSqueal PLUS Service . If you select this option a TaxSqueal representative will contact you via e-mail (or telephone if preferred) regarding the scope and depth of your allegation in an effort to be as specific as possible. Although there is NO guarantee that further actions will be initiated, providing pertinent information that meets certain thresholds and/or criteria will undoubtedly increase the probability of further consideration by the appropriate agencies. There is a $10 charge for this service and you must provide your contact information so that a TaxSqueal representative can contact you.Please Choose*---Please Select The Type Of Submission---Standard Submission - No ChargeAnonymous Mail Notification - $2.00TaxSqueal PLUS - $10.00I Selected Tax Squeal PLUS. Please Contact Me By*PhoneEmailPhone*Email*
