The Taxatic

Please print all required information legibly. Any incorrect or misspelled information can result in a rejected status from the IRS.

Name

First NameLast Name

Middle NamePrefix

Date of Birth

Date

Social Security #

Phone #

Area CodePhone Number

Cell Phone Carrier

Occupation Title

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

**Spouse Information (If n/a, go to next page)**

Required Information

Name

First NameLast Name

Middle Name

Date of Birth

Date

Social Security #

Phone #

Area CodePhone Number

Occupation Title

Email Address

example@example.com

Check box if address is the same as above: O (If different, please completebelow)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How would you like to receive your refund?

Account #

Routing #

Type of Account

A) Dependent Information (If N/A, go to section B)

If you have answered yes to any of the above questions, please provide the other parents name and address:

Were there any legal proceedings, such as custody or divorce in the year of 2021 that can impact child? Yes or No custody filing options?

B. Business Owners (If N/A, go to section C):

Dependent 1 Full Name

Social Security #DOB

ReleationshipMonths in Home with Parent

Dependent 2 Full Name

Social Security #DOB

ReleationshipMonths in Home with Parent

Dependent 3 Full Name

Social Security #DOB

ReleationshipMonths in Home with Parent

Can any of these dependents be filed by another individual?

Do you have joint custody?

Does your child spend more than vacations and holidays with the other parent?

Were there any legal proceedings, such as custody or divorce in the year of 2021 that can impact child?

If you have answered yes to any of the above questions, please provide the other parents name and address:

Other Parents Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

B) Business Owners (If n/a, go to section C)

Business Name

Business Type/Industry

Business Fed ID Number (EIN)

Complete Business Address

When did you acquire or lstart this business?

You are required to provide me with all receipts, ledgers or any method of documentation used to track your expenses and earnings. All representatives assocated with this Firm will only file what you provide as proof of expenditures/earnings.

Select all forms applicable to your filing profile:

Mortgage Interest Statement Form 1098		Gambling Winnings
Student Loan Interest Statement Form 1098-E		Employees Withholding Allowance
Tuition Statement Form 1098-T		Interest income Form 1099-INT
W-2 /1099		Social Security Benefits Statement Form SSA-1099
Health Coverage Forms		Investment Credit Form 3468
Economic Impact Payment Letter 6475		Copies of State Issued IDs
Advanced Child Tax Credit Letter 6419		Proof of Dependent Care/Child Care Expenses

**Please provide these attachments in your email for verification of filing**

AFFADAVIT OF GOOD MORAL CHARACTER FOR PURPOSES RELEVANT TO CHAPTER 812 AND 817

PLEASE PRINT ALL REQUIRED INFORMATION LEGIBLY. ANY INCORRECT OR MISSPELLED INFORMATION CAN RESULT IN REJECTED STATUS FROM THE IRS.

STATE OF GEORGIA (Applicable State In which the client is filing)

Before me this day personally appeared, blanks.

Who, being duly sworn, deposes and says: as a respectable client of Krista The Taxatic, I hereby attest to meeting the requirements for receiving tax services, that am of good moral character, that I have not been found guilty, regardless of adjudication of any of the following offenses:

A violation relating to theft, robbery and related crimes. A violation relating to fraudulent practices (such as false information and/or documents Ifurther attest that all information submitted is true and accurate to the best of my knowledge, and I further attest that all information submitted to the tax preparer belongs to

I understand that I am solely responsible for information and documentation to support the claim of and not restricted to EIC, Child Dependent Care Credit, Gas/Fuel Credit, Depreciation and any Education Credits. If forms are added to my tax filings without supporting documentation I take sole liability for Internal Revenue Service retribution or penalties.

I authorize Krista The Taxatic and its employees to provide consulting, accounting and/or tax preparation services. I will provide all information necessary to complete an accurate return. I am responsible for the accuracy of that information.

Client Signature

Date

Spouse Signature

Date