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Tax Fraud Referral Form
Taxpayer in Violation
Name
Name
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Address
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Zip Code
Zip
Phone Number
Occupation
Business in Violation
Name
Name
DBA
Address
Address
City
State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Zip
Phone Number
Business Activity
Alleged Violation of Tax Law
Check all that apply
Alleged Violation of Tax Law Checkboxes
False Exemptions
False Deductions
Multiple Filings
Unreported Income
Failure to Withhold Tax
False ID Numbers
Falsified Documents
Failure to File/Pay
Other…
Enter other…
Type of Tax Involved
Check all that apply
Type of Tax Involved Checkboxes
Individual Income Tax
Withholding Tax (W2)
Corporate Income Tax
Sales/Use Tax
Other…
Enter other…
Comments
(Briefly describe the facts of the alleged violation - Who/What/Where/When/How - and how you obtained the information)
Comments area
Questions
Are books/records available?
Yes
No
Do you have any physical evidence?
Yes
No
Do you consider the taxpayer dangerous
Yes
No
Banks, Financial Institutions, Credit Unions Used By The Taxpayer
Name
Name
Address
Address
City
State
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Zip
Referral By
Name
Name
Address
Address
City
state
- None -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Zip
Phone Number
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