Name
First Name
Last Name
(SSN) or Taxpayer Identification Number (TIN)
Date of Birth
-
Month
-
Day
Year
Date
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Marital Status as of December 31st of the tax year
Please Select
Single
Married
Divorced
Separated
Widowed
Did you live in more than one state during the tax year?
Please Select
Yes
No
Dependents
Do all listed dependents live with you for more than half the year?
Please Select
Yes
No
Do you financially support all listed dependents?
Please Select
Yes
No
Has anyone else claimed or will anyone else claim your dependents on their tax return?
Please Select
Yes
No
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Income Information
Did you earn any wages, salaries, or tips during the tax year?
Please Select
Yes
No
If yes, please provide all W-2 forms.
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Did you receive any unemployment compensation?
Please Select
Yes
No
Did you receive any self-employment income?
Please Select
Yes
No
If yes, please provide details (1099-MISC/1099-NEC forms, business expenses, etc.).
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Did you receive any Social Security benefits?
Please Select
Yes
No
Did you receive any investment income (interest, dividends, capital gains)?
Please Select
Yes
No
If yes, please provide 1099-INT, 1099-DIV, 1099-B forms, etc.
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Did you receive any rental income or have any rental property?
Please Select
Yes
No
If yes, please provide details and income/expense records.
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Did you receive any other income not listed above?
Please Select
Yes
No
If yes, please describe and provide any relevant documentation.
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Deductions and Credits
Did you have any student loan interest payments?
Please Select
Yes
No
Did you pay any mortgage interest?
Please Select
Yes
No
If yes, please provide Form 1098.
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Did you pay property taxes on your home?
Please Select
Yes
No
Did you contribute to a retirement account (IRA, 401(k), etc.)?
Please Select
Yes
No
Did you make any charitable contributions?
Please Select
Yes
No
If yes, please provide receipts or documentation.
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Did you have any medical or dental expenses that were not reimbursed?
Please Select
Yes
No
Did you pay for child care while working or looking for work?
Please Select
Yes
No
If yes, please provide details and provider information.
Did you or your dependents attend college or post-secondary school?
Please Select
Yes
No
If yes, please provide Form 1098-T.
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Additional Compliance Questions
Did you receive any letters or notices from the IRS or state tax agency during the tax year?
Please Select
Yes
No
If yes, please provide copies.
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Did you make any estimated tax payments during the tax year?
Please Select
Yes
No
If yes, please provide amounts and dates.
Did you have health insurance coverage for yourself and all dependents for the entire tax year?
Please Select
Yes
No
If no, please provide details about your coverage and any Form 1095-A, B, or C.
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Consent and Authorization
Do you authorize us to electronically file your tax return?
Please Select
Yes
No
Do you consent to have your refund directly deposited into your bank account?
Please Select
Yes
No
If yes, please provide bank account details.
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Final Declaration
I certify that the information provided is true and accurate to the best of my knowledge
Please Select
Yes
No
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