Tax Return Preparer Complaint

Tax Return Preparer Fraud or Misconduct Affidavit

Please complete and submit this affidavit with Form 14157, Complaint: Tax Return Preparer if a Tax Return Preparer filed a tax return or altered your tax return without your knowledge or consent.

Please check all that apply:

I am a victim of preparer fraud or misconduct:

 A Tax Return Preparer filed a tax return using my name and/or Social Security Number without my knowledge or consent.

 A Tax Return Preparer altered my tax return without my knowledge or consent.

 A Tax Return Preparer provided me with a copy of my tax return which is different from what was filed with the IRS.

 A Tax Return Preparer received all or a portion of my refund without my knowledge or consent.

 A Tax Return Preparer had my refund or a portion of my refund direct deposited into an account that was not mine.

 A Tax Return Preparer did not give me a refund.

 A Tax Return Preparer gave me a refund for the wrong amount.

 A Tax Return Preparer gave me a refund check that “bounced”.

Provide a brief explanation and the tax impact: __________________________________

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Taxpayer’s Name:

Last name First name Middle Initial

Taxpayer’s Address:

________________________________________________________________________

Provide the last 4 digits of your Social Security Number (SSN) or your complete Individual Taxpayer Identification Number (ITIN):

_____________________________________

List the Tax Year(s) Impacted (tax years begin on January 1^st and end on December 31^st):

_______________________________________________________________________

Tax Return Preparer’s Name:

________________________________________________________________________

Did you use the preparer for any other year(s) or returns(s)? If so, please list

________________________________________________________________________

Do you have a relationship with the preparer? If yes, please define relationship (friend, neighbor, relative, co-worker, etc).

________________________________________________________________________

How did you find out this person prepared income tax returns?

________________________________________________________________________

Did you receive a refund?

________________________________________________________________________

Do you authorize the IRS to disclose your identity (your name, mailing address, taxpayer identifying number or any combination thereof) and each bank routing and account number listed on your tax return to the corresponding bank in order to determine if the refund was directed to your account?

_______________________________________________________________________

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information entered on this form is true, correct, complete, and made in good faith.

__________________________________ ___________________

(Signature of taxpayer) Date signed

Please submit the following documents with the completed affidavit to verify your claim:

 Copy of the tax return(s) provided to you by the Tax Return Preparer

 Signed copy of the tax return(s) as they were intended to be filed

 Copy of your bank statement(s) reflecting the refund amount you received by direct deposit, if applicable

 Copy of paper check(s) reflecting the amount you received by paper check, if applicable

 Copy of document(s) you received from the Tax Return Preparer

 Copies of additional documents to support your claim

Send Completed Form 14157, the Tax Return Preparer Fraud or Misconduct Affidavit and copies of documents to:

Internal Revenue Service

AM – Preparer Complaints

5333 Getwell Road

Mail Stop 58

Memphis, TN  38118