Form 13424 - Low Income Taxpayer Clinic (Litc) Application Information Page 2

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Low Income Taxpayer Clinic (LITC)
OMB Number
Application Information
1545-1648
Qualified Tax Expert (QTE)
Prefix
Last name
First name
Middle initial
Suffix
Telephone number
Email address
Licenses/Certifications (Check all that apply)
Attorney
CPA
Enrolled Agent
Other
Qualified Business Administrator (QBA)
Prefix
Last name
First name
Middle initial
Suffix
Telephone number
Email address
13424
Form
(Rev. 9-2012)
Catalog Number 36126D
Department of the Treasury - Internal Revenue Service

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