Client Information Form
Tax Lady Enterprises
Primary Taxpayer Name
*
First Name
Last Name
Date of Birth (Primary Taxpayer)
*
-
Month
-
Day
Year
SSN (Primary Taxpayer)
*
Joint Taxpayer Name
First Name
Last Name
Date of Birth (Joint Taxpayer)
-
Month
-
Day
Year
Date
SSN (Joint Taxpayer)
000-00-0000
Best Phone Number
*
-
Area Code
Phone Number
Best Email
*
example@example.com
Primary Taxpayer Occupation
*
Joint Taxpayer Occupation
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
FILING STATUS
*
Single
Head of Household
Married-Joint
Married-Separate
Widower
Unsure
Type of Income
*
W-2
1099
Self Employment
Unemployment
Other
2022 Income
Do you have an IP Pin? Please upload current 2023 letter from IRS below
Identity Protection Pin #
Do you have health insurance thru the Marketplace (Obama care / Healthcare.gov) 1095 A form
Yes
No
Unsure
Dependent Information
First Name
Last Name
Birthdate
Social Security #
Relationship to you
Did dependent live with you all year? (Y/N) How many months?
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Did you pay daycare/school expenses for your dependents?
Yes
No
Did you live in or earn money in more than one state?
List the states you lived in / Earned $ in 2023
Please attach one or more Dependent documentation here (Birth Certificate(s), Report Card, SSN card, Daycare Payments, etc.)
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Attach Valid Photo Identification for everyone 18 yrs. & up listed on tax return
*
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Driver's License or State ID card
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Attach Income Documentation: (W-2, 1099'S, ETC...)
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Attach any other documentation you may use to file taxes (School Forms 1098T, Mortgage Form, Contribution Statement, Itemized Expenses, Investment Forms 1099R, other 1099's, etc.)
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Attach your 2022 Tax Return
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New Clients Only
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ADDITIONAL DOCUMENTS
Preferred Refund Method
Check (Received at Tax Office)
Direct Deposit
Prepaid Card
Upload Direct Deposit Information **if direct deposit was selected
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Voided Check, Direct Deposit Form OR Account & Routing #'s
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What type of appointment would you prefer?
*
Phone Call
Virtual (Zoom)
In-Person
Other
Who referred you
List any people you may have referred
Signature
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