Texas Accountants and Lawyers for the Arts INDIVIDUAL APPLICATION FOR LEGAL OR ACCOUNTING ASSISTANCE Please answer the following questions: Name Today’s Date Street Address Apartment/Suite Number City, State, and Zip Code Phone Number Alternate Phone Number or Fax Number Email Address Are you currently a member of TALA? What type of art do you create? Dance Music Other Yes No Literature Film/Video/New Media Theatre/Performance Visual Art (painting, sculpture, etc.) What is your legal or accounting problem? Please include details. If there is an adverse party related to this problem, please provide the name, company and phone number of the party or their attorney. Name Company Phone Number If you have previously consulted an attorney or accountant about this problem, please provide their contact information below. Name Email Firm Phone Number Financial Information Please note that applications cannot be considered without the following information: What is your household adjusted gross income based on last year’s federal tax return (line 33 on Form 1040 or line 21 on 1040A)? How many dependents are in your household? What is your approximate income to date for the current year? Please include a copy of your most recent income tax return, including Schedule C, if filed with your return. How did you hear about TALA? TALA is not staffed to provide emergency legal or accounting assistance. Please be prepared to wait for your application to be processed and a volunteer matched to your case. TALA does not charge for professional services. Once a referral has been made, however, clients are responsible for filing and other fees. TALA does not ask its volunteers to litigate matters. Volunteers will, however, try to negotiate a solution on your behalf and/or advise you on the merits of resolving your dispute through mediation or in small claims court. I understand that TALA can neither guarantee that it will be able to refer my case to a volunteer nor that the representation will be successful. TALA is merely a referral organization. I understand that TALA makes no representation as to the skill of the referral attorney/accountant. I understand that I will be represented by the volunteer or the volunteer’s firm and not by TALA. I agree that in the event litigation or arbitration becomes necessary, I will not oppose my volunteer’s decision to withdraw from representation. I agree to promptly notify TALA if I no longer need the assistance of a volunteer. Signature Date Please return this form with your income documentation to TALA, 1540 Sul Ross Street, Houston, Texas 77006 | FAX: (713) 526-1299 | EMAIL: info@talarts.org