Income Tax Data Form

Customer Data Sheet

This form is to be completed by client
Preparer Name:*
Tax Year:
Referral Name
Name
Please choose which forms you want to file:

FederalState
Filing Status
Occupation:
Job Status
Occupation Spouse :
Job Status
Primary Filer's Information
Name

First NameLast Name
Date of Birth
Social Security Number*
xxx-xx-xxxx
DL or ID # blanks
Issue Date blank*
Expiration Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email Address
Spouse Information

If Applicable
Spouse:

First NameLast Name
Date of Birth
Social Security Number
xxx-xx-xxxx
DL or ID # blanks
Issue Date blank
Expiration Date
Phone Number

Area CodePhone Number
Email Address
Can someone else claim you as a dependent?

YesNo
Dependent's Information
Name of Dependent
Date of Birth
SSN#
Relationship
Name of Dependent
Date of Birth
SSN#
Relationship
Name of Dependent
Date of Birth
SSN#
Relationship
If you have more dependents please send information in Browse Files section
Source of Income. Check the Income(s) Items Which Pertain to You.
Wages or Salary (W2 Income)UnemploymentPension/Retirement IncomeRental IncomeFarm IncomeDividend/Sale of Stocks
Interest Income 1099 INTSelf-Employment-Bus. Income (Sch.C)Alimony ReceivedLottery or Gambling Income W-2GPublic/State Aid IncomeSocial Security IncomeTipsOther Income
Source of Expenses. Check the Expenses Which Pertain to You
IRA'sProperty TaxMortgage Points(closing points)Business Owner/Self EmployedTax Prep ExpensesUnion DuesEducation ExpenseSignificant Loss or Theft
Charity of Religous ContributionsMortgage InvestmentMoving ExpensesMedical ExpenseAlimony PaidBuy or Sell HomeJob Related ExpensesOther
Child Care Information(Credit)
Provider Name
EIN(Tax ID#)
Provider Phone Number

Area CodePhone Number
Provider Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I give JAM Crew Taxes permission to electronically file and deduct their final tax fee(s) from my irs refund (Initial Below)*
Did you purchase health care through Healthcare.gov or Statemarket place*

YesNo
If did purchase please submit 1095-A In the browser section.

⬇️Below⬇️
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You can upload as many files as needed!
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Client Signature*

Clear
Date

MonthDayYear
Date
Spouse Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Customer Data Sheet

Primary Filer's Information

Spouse Information

Dependent's Information

Source of Income. Check the Income(s) Items Which Pertain to You.

Source of Expenses. Check the Expenses Which Pertain to You

Child Care Information(Credit)