Form 14157 (2012) Complaint: Tax Return Preparer Page 2

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Control Number:
Department of the Treasury - Internal Revenue Service
14157
OMB Number
Form
Complaint: Tax Return Preparer
1545-2168
(Rev. May 2012)
11b. Provide facts and other information related to the complaint (attach additional sheets if necessary)
Your Contact Information
(optional)
12. Relationship to Preparer
Client
IRS employee
Return preparer working for a different firm
Other (specify)
Return preparer working for the same firm
Your name (Last, First, MI)
Date of complaint
Your mailing address (street, city, state, ZIP code)
Your telephone number(s) (include area code)
Your email address
Send completed form along with any supporting information to:
Attn: Return Preparer Office – Mail Stop 58
1122 Town & Country Commons
Chesterfield, MO 63017-8200
Note: If Form 14157-A is also required, send both forms (Form 14157 and Form 14157-A) to the address shown in the Instructions for
Form 14157-A, and not to the address listed above.
14157
Form
(Rev. 5-2012)
Catalog Number 55242M

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