Form 14157 - Complaint: Tax Return Preparer
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Department of the Treasury — Internal Revenue Service
14157
Form
OMB No. 1545-2168
Complaint: Tax Return Preparer
(July 2011)
Information About the Return Preparer
(Complete All Known Information)
1. Preparer's Professional Status
:
(check all that apply)
Attorney
CPA
Enrolled Agent
Registered Tax Return Preparer
Other / Unknown
2. Preparer's Name and Address
3. Preparer's Business Name and Address
(if different)
4. Preparer's Telephone Number
5. Business Telephone Number
(include area code)
(include area code)
6. a. Preparer's E-mail Address
7. Fax Number
(include area code)
8. Preparer Electronic Filing Identification Number
(EFIN)
6. b. Preparer's Website
9. Preparer Tax Identification Number
10. Preparer Social Security Number
11. Employer Identification Number
(PTIN)
(SSN)
(EIN)
12. Tax Year(s) impacted
(Complete if Known)
Nature of Complaint
13. a. Check all that apply:
Failure to Send Employment
False Exemptions or Dependents
Misrepresentation of Credentials
Taxes or Withholding to IRS
False Expenses or Deductions
Paid Preparer Failed to Sign
Paid Preparer Filed Returns
or Credits
Using Off Shelf Software or
Paid Preparer Failed to Provide
Free File
False or Overstated
Copy of Return
W-2 or Form 1099
Paid Preparer Provided a Copy
Paid Preparer Failed to Return
that is Different from What was
False or Altered Documents
My Records
Filed
Incorrect Filing Status
Paid Preparer Diverted Refund to
Other
(explain)
Unknown Account
Theft of Refund
Omitted Income
PTIN Missing
E-filing Using Payroll Stub
PTIN Misuse
E-filing Cash Advance
13. b. Provide facts and other information related to the complaint
14157
Catalog Number 55242M
Form
(Rev. 07-2011)
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