Perez Tax Express
Intake Form
Full Name / Nombre Completo
*
First Name
Last Name
Full Name Of Spouse / Nombre de Esposo(a)
First Name
Last Name
SSN/ Seguro Social
111-11-1111
Address / Direccioń
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number / Numero de Telefono
*
Format: (000) 000-0000.
E-mail / Correo Electronico
*
example@example.com
Occupation
*
Filing Status / Estatus De Declaracioń
*
Please Select
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widower
Name of Dependants *If applicable / Nombre de dependientes *Si es aplicable
Child Care Provider / Cuidador Infantil
YES
NO
Check The following Forms If Applicable / Verifique los siguientes formularios si corresponde
*
W-2
1099NEC
1099G
1099R
Other
File Upload of Photo ID and other Tax Docs/ Carga de archivos de identificación con foto y otros documentos fiscales
*
Browse Files
Drag and drop files here
Choose a file
PLEASE SUBMIT PHOTO ID'S, SOCIAL SECURITY CARDS AND ALL NECESSARY TAX DOCUMENTS FOR QUICK PROCESSING
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of
Signature / Firma
*
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