OMB Number 1545-2219
Catalog Number 57652G
All fields marked with an asterisk (*) are required.
e.g., seminar, internet, email, TV, flyer, newspaper, magazine, friend,
relative, etc.
You may use the space bar to open the calendar. Future dates are not accepted
Website address must include at least one period
Phone number may only include numbers, letters, spaces and dashes. A phone number with just zeros is not accepted.
(if known). Do not include dollar signs, commas, or cents. ex. 1500
e.g., brochures, prospectus, etc.
Phone number may only include numbers, letters, spaces and dashes.
Email address must include at least one '@' symbol
Describe the suspected tax scheme being promoted
N/A
How did you become aware of the promotion or promoter
When did you first learn about the tax promotion
Name of Promoter(s)/Tax Preparer(s)
Social Security Number (SSN) and/or Preparer Tax Identification Number (PTIN)
Mailing address of Promoter/Preparer
Website
Telephone number of Promoter/Preparer
Do you have copies of any promotional material supplied by the promoter
Cost
Is the promotion still active
Describe how the promoter or preparer was involved in the promotion
What is your current relationship with the Promoter(s)/Preparer(s)? Did you purchase the promotion strategy
Do you have any additional information that you would like us to consider
Name
Enter the date you completed this form
2025-03-26
Mailing address
Telephone number
Email address