Tax Seller Servicing Application

Royalty Tax Service

1.844.826.2TAX (2829)

(Please provide a copy of last year's tax return)

DATA INPUT FORM

Taxpayer Name *

First Name Middle Name Last Name

SSN *

DOB *

Driver's License *

Driver's License State *

Occupation *

Cell Phone *

Area Code Phone Number

Work Phone

Area Code Phone Number

Home Phone

Area Code Phone Number

E-mail Address *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Filing Status: *

Single Married Filing Separated(Please fill Spouse's Name) Head of Houshold Qualifying Window or Widower Spouse's date of death Married Filing Joint

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Spouse Name (if filing jointly or separately)

First Name Middle Name Last Name

SSN

DOB

Driver's License

Driver's License State

Occupation

Facebook

Phone Number

Area Code Phone Number

E-mail Address

example@example.com

Dependents If any (scroll over on mobile)

	Name	DOB	SSN	Relationship	Months in the house	Disabled
Dependent
Dependent
Dependent
Dependent

Did you receive 3rd Stimulus payment *

Yes No

Did you pay for child daycare? *

No

Did you recieve child tax credit advance payments? *

No

Are you or your spouse permanently disabled? *

Yes No

Do your children reside with you but are being claimed by someone else? *

Yes No

Will you be claimed as a dependent on someone else's tax return? *

Yes No

Did you or anyone receive insurance through the market place? *

Yes No

Did you file taxes last year *

Yes No

Have you recieved a letter or notification from the IRS in the past three years? *

Yes No

Do you owe the IRS or any government agencies *

Yes No

Check those that apply

Direct Deposit (scroll over on mobile)

	Bank name	Account Type	Routing#	Account#
Direct deposit

How were you referred to us?

Where did you file last year?

Reference

Name and/or Number

Reference

Name and/or Number

Reference

Name and/or Number

Here you may upload any or all necessary documents needed to file your taxes such as W-2's, 1099's, identification, etc

Upload a File

Ask questions or concerns regarding your tax expenses

READ AND UNDERSTAND

This firm and its employees will comply with all of the provisions of the Revenue procedure for electronic filing or individual and business income tax returns, and related publications of each year of our participation.

Under the penalty of perjury, I/We declare that I/We have read and examined this application and accompanying information, and hereby certify that the information being provided above is true, complete, correct and accurate to the best of my/our knowledge and belief.

Customer Signature *

Clear

Date

Spouse Signature

Clear

Date

Office Use Only

I hereby certify that the return was prepared with information provided to me by the taxpayer whose signature appears above.

If fraud is suspected, i will notate the file and take neccessary action.

This return was prepared by

Tax Professional Signature

Clear

Date