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TAX Questionnaire

Please fill out the following form to help us understand your tax situation.

First Name

SSN

Spouse First Name

SSN

Address

State

Email Address

Last Name

Date of Birth

Spouse Last Name

Date of Birth

City

Zipcode

Phone

Dependent First Name

Relationship to Taxpayer

Dependent Last Name

Date of Birth

SSN

Months Lived in Home

Dependent First Name

Dependent Last Name

SSN

Relationship to Taxpayer

Date of Birth

Months Lived in Home

Is someone else claiming you as a dependent? *

No

Yes

Did you and your spouse live apart during the year? *

No

Yes

Did you pay estimate Federal / state tax last year? *

No

Yes

If Yes How Much?

Did you itemize last year? *

No

Yes

Did you have medical insurance last year? *

No

Yes

Were you or your spouse a resident of another state? *

No

Yes

Did you earn income from another state? *

No

Yes

Did you use your personal vehicle for work? *

No

Yes

If Yes were you reimbursed?

No

Yes

Did you purchase a home last year? *

No

Yes

What Month?

Would you like your refund deposited into your bank? *

No

Yes

Routing Number

Account Number

CHECK ALL THAT APPLY

W-2 Wage Statement

1099s

IRS's

Stcks and Bonds

Moving Expenses

Received Unemployment

Alimony (Paid or Received)

Education Expenses

Own Rental Property

Recieved Interest

Received Dividends

Pension or Retirtement

Social Security Income

Own a Business or Self Employed

Tips/ Other INcome

Union Dues

Job Related Expenses or Training

Lottery or Gambling Winnings

Charity or Religious Contributions

Property Tax

Mortgage Interest

Mortgage Points / Closing Points

Medical Expense

Tax Preperation

Buy or Sell a Home

Farm Income

Loss or Theft

MISCELLANEOUS ITEMS

Child Care Provider Name

Child Care Provider Address

I declare that the info I’ve provided is accurate & complete

I certify that I would like my taxes prepared according to the information I have given

Child Care Provider SSN/EIN

Amount Paid

Today's Date

Your Signature

Upload Documents Needed to File

Upload File

Upload supported file (Max 15MB)

We've recieved your submission successfully!

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