Mimms Tax Service
2021 Tax Return Questionnaire
Are you new to Mimms Tax Service?
Please provide information on who referred you. They could get $50
Referrer Phone Number
Please email or upload here the following(if applicable) to firstname.lastname@example.org:
Social Security Card
Personal Taxpayer PIN (if applicable)
Dependent Information (ssn, birth certificate, proof of residency, etc)
Head of Household (non-married with dependent)
Married Filing Jointly
Married Filing Separate
Primary Filer's Information
Date of Birth
Street Address Line 2
ex SSn, ITIN
Can/Will you be claimed as a dependent this year?
Date of Birth
ex: SSN, ITIN
Please provide the name, relationship, birth date, and social security number for each dependent in the boxes. Unless previously provided, documentation will need to be uploaded. (Check the bottom of the form.)
Upload all relevant documents or bring them to the office
EIP #3 amount?
Check all that apply:
Self-Employment (Sch C)
If filing Schedule C, total your expenses for the year and how much income you grossed.
Consider these when calculating expenses:
Automobile usage (mileage, gas, etc)
Home use for business
Supplies Bought (Any records or receipts?)
Utilities or Taxes paid
Other related expenses
Write your expense and the total amount you paid for the year.
Total Gross Income
Are you interested in applying for an advancement loan?
EPS Tax Return Advancement
Mimms Tax Service Advancement
Upload any other relevant tax documents
Type any questions, comments or concerns here.
Please verify that you are human
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