2021 Taxes

Name

First Name Last Name

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What was your filing Status as of Dec 31 2021?

Single Married filing separately Married filing jointly Head of Household

Phone Number

Please enter a valid phone number.

Preferred Method of Contact

Were you referred to PAK, and if so by whom?

Did PAK Accounting prepare your taxes last year?

Yes - if so you do not need to input personal information unless something has changed. No

How would you like your refund?

Direct Deposit Prepaid Card

Tax Payers Date of Birth

Taxpayer Social Security Number

How many W2's Does The Tax Payer Have?

Spouse's Full Name

Spouse's Date of Birth

Spouse's Social Security Number

How many W2's Does Your Spouse have?

Spouse's Phone Number

Spouse's Email Address

Please upload W2's

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Name of Bank

Routing Number

Bank Account Number

Can anyone claim you as a dependent?

Yes No

Did you support a child or family member for more than 6 months out of the year?

Yes No

How many dependents are you claiming?

One Two Three Four N/A

Dependent #1 Full Name

Dependent # 1 Date of Birth

Dependent # 1 Social Security Number

What is the relationship to dependent # 1 (son, daughter, nephew)?

How many months did dependent #1 live with you in 2021?

Dependent # 2 Full Name

Dependent # 2 Date of Birth

Dependent # 2 Social Security Number

What is the relationship to dependent # 2 (son, daughter, nephew)?

How many months did dependent # 2 live with you in 2021?

Dependent # 3 Full Name

Dependent # 3 Date of Birth

Dependent # 3 Social Security number

What is the relationship to dependent # 3 (son, daughter, nephew)?

How many months did dependent # 3 live with you in 2021?

Did your dependents attend daycare or any after-school care for 2021?

Yes No Type option 4

If so, please upload the form you receive from the daycare provider.

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Please upload prior year tax returns if PAK did not complete.

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Did you receive the EIP3 on or around March 2021?

Yes No Other

Did receive the child tax credit in 2021?

Yes No N/A

If you had insurance through the marketplace, did you receive a 1095A Health Insurance Marketplace statement? (Not providing form IRS could delay your refund)

Please upload your marketplace statement

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Do you own a business and/or were you self employed?

Yes No

If you do not have any 1099 please provide business name and EIN#

Did you incur material expenses to operate your business in 2021?

Yes No N/A

If you incurred and business expenses please list here or upload your profit and loss or list below.

If you owned a business or were self employed, please upload 1099 and or Profit and loss.

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Have you ever been denied the Earned Income Tax Credit (EITC)?

Yes No

Did you attend college in 2021?

Yes No

Did your spouse attend college in 2021?

Yes No N/a

Do you have a Form 1098T (Tuition Statement) for either you, your spouse and/or dependents?

Yes No

Did you receive your all your stimulus payments?

Yes No If so how much

Did you receive your child tax payments?

Yes $300 for 6 months Yes $250 for 6 months Yes partial payments No

If you were self employed in 2021, were you unable to perform services because of certain corona virus related circumstances?

Yes No N/A

Upload drivers license

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