Fillable Printable Form P-626 - Wisconsin Department Of Revenue
Fillable Printable Form P-626 - Wisconsin Department Of Revenue
Form P-626 - Wisconsin Department Of Revenue
2a. Amount of unreported income and tax years (fill in tax years and dollar amounts, if known; e.g., TY 2006, $20,000)
2b. Other type of tax violation, for example overstated expense, wrongly claimed dependent, ineligibility for certain credits,
etc. Describe in comments below.
Comments. Briefly describe who, what, where, when and how. (Attach 2nd page if more space is needed.)
1. Type of tax violation (check all that apply)
Income tax or withholding tax Sales and use tax Corporation franchise/income tax Other
INFORMATION ON BUSINESSINFORMATION ON INDIVIDUAL
P-626 (R. 5-16) Wisconsin Department of Revenue
Wisconsin Tax Information Referral Form
Person’s name
Street address
City State Zip
Social security number Date of birth
Occupation
Marital status (check one)
Business name
Street address
City State Zip
Employer identification number
What kind of business? (e.g., grocery store)
Name of spouse, if applicable
Married
Divorced
Single
Separated
Head of household
TAX YEARAMOUNT
$
TAX YEARAMOUNT
$
TAX YEARAMOUNT
$
TAX YEARAMOUNT
$
3. Are books / records available? Yes No
4. Do you consider the taxpayer dangerous? Yes NoIf yes, why?
5. Banks, financial institutions used by taxpayer:
6. Please describe how you learned and/or obtained the information in this report (attach 2nd page if more space is needed):
Name
Address
City State Zip
Name
Address
City State Zip
Address
City State Zip
Your name
Telephone number (include area code)
Mail this form to:Wisconsin Department of Revenue
Audit Bureau, MS 5-144
PO Box 8906
Madison WI 53708-8906
Fax: 608-221-6637
Questions about this form: Call 608-266-2772
7. If we have additional questions, can we contact you? Yes No
8. Do you want to remain anonymous? Yes No
Email Address
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the contact information at the bottom of the page.
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2. Comments. Briefly describe who, what, where, when and how.
P-626 (R. 5-16) - 2 -Wisconsin Department of Revenue
6. Please describe how you learned and/or obtained the information in this report:
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