United Tax Services Client Form

Put the name of the person who will prepare your tax return.
Customer Name
Address
City, State, Zip
SSN
DOB
Phone Number

Area CodePhone Number
Email
example@example.com
Did you pay over half the expenses of maintaining your household for the entire year?
What is your marital status on December 31st? Not married ,married and live with spouse,married but live apart from spouse
IF YOU WILL BE CLAIMING HEAD OF HOUSEHOLD UPLOAD A LEASE AGREEMENT OR UTILITY BILL WITH FROM PRIOR YEAR DATE

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Do you receive any Government Assistance? If so how much?
Spouse Name
Occupation(Job Title)
Spouse DOB
Spouse SSN
Cell Number #:
Email
johndoe@gmail.com
Spouse Occupation
Referred by:
Driver Lic #:
Spouse Driver Lic #:
State ID #:
Spouse State ID #:
Issue Date:

MonthDayYear
Date
Spouse Issue Date:

MonthDayYear
Date
Spouse Expiration Date:

MonthDayYear
Date
Expiration Date:

MonthDayYear
Date
Please upload all Social Sec Cards Taxpayer, Spouse and ALL Dependents.

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Please upload your State ID or Drivers License Taxpayer and Spouse.

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Please upload your something that proves your dependent lives with you at your address . It can be a piece of mail with both names and address, Shot record, Health ins form, school paper, Food stamps application ,Medicaid form, Lease agreement, Childcare facilty, Social service agency or Social Security letter.

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******Please upload Birth Certificates for all Dependents you are claiming!!! This is a MUST!!!

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Check Your Source of income?

(Job) W21099 ContractorSelf EmployedSSI/SSAUnemploymentOther
W2 , 1099 ,Unemployment

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W2 , 1099 ,Unemployment

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W2 , 1099 ,Unemployment

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Do you have Marketplace Healthcare Insurance (OBAMA CARE) You are any of your dependentS?

YesNo
Please upload Marketplace insurance form here. (1095A)

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Do you have any Unfiled tax returns?

YesNo
Were you already claimed as a Dependent?

YesNo
Has the IRS ever issued you an Identity Theft Pin Number?

YesNo
Please upload your Idenity Theft Pin letter here.

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Do you owe the IRS, Delinquent Student Loans, or Back Child Support ?

YesNo
How would you like your refund?

Direct DepositCheck
Bank Name:
Check the following:

Checking AccountSaving Account
Blank check for verification

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Bank Routing #:
Bank Account #:
Did you pay child care expenses?
Upload child care form here.

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If you paid childcare to an individual put individual name,address & social security number.
List Dependents that Receive childcare Assistance?
Were you a Fulltime college student in 2024?

YesNo
Did you claim the college credit for 4years?
Upload Documents (COLLEGE FORMS 1098T FORM)

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Please list every w-2 , 1099 or any other tax document that United Tax will be preparing for you for 2023(example: Wendys ,McDonald ,Krystal , 1099NEC. If you leave out any tax forms you will be charged $149.00 per form . United tax service will have to file an admendment on your behalf. Please give us ALL income documents now! OR wait until you have received all of your tax documents to file your taxes .
Please sign stating you agree to the above terms.

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Sworn Statement of Residency
Name of Parent(s) or Guardian(s)
blanks
Dates the dependent(s) lived with you in the Calendar Year 2024
Address that your dependent(s) lived at with you in the Calendar Year 2024
List of all dependents that lived with you from your tax return.
I am certifying that the dependents listed above that I am claiming on my 2024 tax return has lived with me at the address above for more than 6 months in 2024 in the United States.
If I was audited by the IRS of EITC, Head of Household or Child Tax Credit I would be able to provide the documents below to prove residency of my dependent:

School RecordsMedical RecordsDaycare RecordsLease AgreementOther Documents
I hereby affirm under penalty of perjury that the facts set forth in this statement are true:

Taxpayer Signature
Signature Date

Taxpayer Print Name
First Name Last Name
Please sign stating you agree to the terms above,

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NOTICE: (1) By signing form below, I certify that all information is true, Complete, and accurate. I understand that false information may be grounds for the federal government to seek criminal charges against myself. I also release United Tax Services from any liability related to the information provided. My signature also authorized United Tax Services to electronically file my tax year 2024 income tax return. I am aware my refund can take typically between 9 to 21 business days to deposit in my account.

NOTICE: (2) It is important that you present all your income and expense statements i.e. W-2, unemployment, retirement, P&L, etc. Failure to report such documents could result in the delay of your refund and or you will receive an IRS audit notice via mail. If you have read and understand this notice, please sign and date below.
Tax Payer Signature*

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Date*

MonthDayYear
Date
Spouse Signature

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Date

MonthDayYear
Date
United Tax Services
Should be Empty:

Sworn Statement of Residency

United Tax Services