Client Information Sheet

Taxpayer Name*
Date of Birth*

MonthDayYear
Date
Occupation
Email*
example@example.com
Cell/Home #*
Spouse Name
Date of Birth

MonthDayYear
Date
Occupation
Email
example@example.com
Cell/Home #
Address*
City, State, Zip*
MARITAL STATUS AS OF LAST DAY OF YEAR:

Please Type YES under the filing status below that best fits your situation.
If Filing Single Type Yes
If Filing Married Type Yes
If Filing Divorced Type Yes
If Filing Separated Type Yes
If Filing Widowed Type Yes
If widowed, what year
For Dependents Below:
- List the names as it appears on the Social Security Card of everyone for which you provided more than 1/2 of the total support (other than your spouse)
- Date of Birth
- Relationship
Depedent Name
Dependents Name
Dependents SS Number
Date of Birth

MonthDayYear
Date
Dependents Relationship to Taxpayer
Months In-Home
Dependents Name
Dependents SS Number
Date of Birth

MonthDayYear
Date
Dependents Relationship to Taxpayer
Months In-Home
Dependents Name
Dependents SS Number
Date of Birth

MonthDayYear
Date
Dependents Relationship to Taxpayer
Months In-Home
Dependents Name
Dependents SS Number
Date of Birth

MonthDayYear
Date
Dependents Relationship to Taxpayer
Months In-Home
Dependents Name
Dependents SS Number
Date of Birth

MonthDayYear
Date
Dependents Relationship to Taxpayer
Months In-Home
Driver License State
Driver License Number
Driver License Issue Date
Driver License Exp Date
Bank Name
Routing Number
Account Number
By signing below, I/we attest that all above information is accurate and nothing has been falsified for my/our tax return.
Taxpayer Signature*

Clear
Spouse Signature

Clear
Date*

MonthDayYear
Date
Should be Empty:

Depedent Name