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7. Eligibility Information

YES

a. Are you a successful Special Enrollment Examination candidate?

(If “Yes,” attach copy of letter advising you of this.)

b. Are you a former Internal Revenue Service employee seeking enrollment

under section 10.4(b) of Treasury Department Circular No. 230?

(If “Yes,” complete Schedule A.)

c. Are you an attorney or certified public accountant applying for reinstatement as

an enrolled agent as a result of the 1994 changes to Treasury Department Circular No. 230?

d. Have you read and are you familiar with Treasury Department Circular No. 230?

If you answered “No” to question 7a and 7b and 7c, DO NOT COMPLETE this FORM. You are not eligible to become an enrolled agent.

8. Professional Practice and Other Data

YES

(If any answer to 8a through 8f is “YES,” explain in detail in Schedule B.)

a. Have you ever been cited to appear before any professional body for alleged misconduct?

b. Have you ever previously filed a Form 23, Application for Enrollment to Practice Before

the Internal Revenue Service?

c. Have you ever been previously enrolled to practice before the Internal Revenue Service?

(If “Yes,” enter your enrollment number.)

d. Has any application for admission to practice you filed with a court or government department,

commission, or agency, ever been denied or rejected?

e. Has any Internal Revenue Service office ever held you ineligible for limited practice without enrollment?

f. In the last 10 years or since your 18th birthday if sooner, have you ever been convicted or fined for the violation of any

law, police regulation, or ordinance (excluding minor traffic violations for which a fine or forefeiture of $500 or less

was imposed)? If “Yes,” give details of each case in Schedule B, including the date and nature of the offense or violation,

the name and location of the court, any penalty imposed and/or other disposition of the matter

NOT

9. Tax Return Information

YES

REQUIRED

a. Were you assessed a penalty or addition to tax with regard to any tax matter for which you had responsibility,

including estimated tax payments for the current year or preceding 3 years?

(If “YES,” explain in detail in Schedule B.)

b. Did you timely file your required Federal Tax returns and pay all taxes due for the current year and each

of the preceding 3 years?

(If “NO” explain in detail in Schedule B. Include in your explanation the existence of any installment agreement

relative to unpaid taxes.)

c. Please COMPLETE this section for any returns filed under (b.) above as it relates to you individually or in your

business capacity. e.g. Partner, Officer or Business Owner. Attach additional pages if you need more space.

Taxpayer

Enter Exact Names and Addresses

Type of Return (940, 941, 1040, 1041,

Year

Identification

As Shown on the Returns

1120, 1120-S 1045, 720, etc.)

Number

19__

20__

Form 23 (Rev. 9-2000)

Page 2

Catalog Number 16233B

Form 23 - Application For Enrollment To Practicebefore The Internal Revenue Service - 2000 Page 2

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