Client Tax Data Sheet
Fill out the form below to submit your tax information to me. If you have any questions prior to completing this form, do not hesitate to contact me by email at fbsscreening@gmail.com or by phone at (470)242-4106. Thank you and have a great day!
How did you hear about us or who referred you?
First Name
*
Middle Name
Last Name
*
Suffix
Jr, Sr, II, III
Social Security Number
*
Date of Birth
*
/
Month
/
Day
Year
Date
Occupation
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Driver's License #
*
State Driver's License Was Issued
*
Date Driver's License Was Issued
*
MM/DD/YYYY
Driver's License Expiration Date
*
MM/DD/YYYY
Photo of Social Sec. Card & Driver's License
*
Choose File
Identification
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What is your filing status?
*
Choose One
Single
Head Of Household (Single with dependents)
Married Filing Joint
Married Filing Separate
Are you filing an eligible spouse on your tax return?
*
Yes
No
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Spouse Name
First Name
Middle Name
Last Name
Suffix
Social Security Number
*
Occupation
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Driver's License #
*
State Driver's License Was Issued
*
Date Driver's License Was Issued
*
MM/DD/YYYY
Driver's License Expiration Date
*
MM/DD/YYYY
Photo of Driver's License
*
Choose File
Identification
Cancel
of
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Payment/Refund
(Checks can be picked up in office or sent via mail)
Select below the method that you prefer to receive your refund
*
Direct Deposit
Bank Name (Skip If You Prefer Your Refund Via Check)
Bank Account Number
Bank Routing Number
Account Type
Checking
Savings
Are you interested in applying for a cash advance? (Up to $7000)
Yes (bank fees apply)
No
Is this year your first year filing your taxes with FBS Screening?
*
Yes
No
Did your marital status change during the year?
*
Yes
No
Did you have Marketplace Health Insurance (Obamacare-ACA) this year? (Should receive Form 1095-A)
*
Yes
No
Did you attend a College or university last year?
Yes
No
Do you currently have an offsets with the IRS (delinquent student loans, delinquent child support, tax liens etc)? *If you suspect that you have an offset call (800)304-3107 to confirm
*
Yes
No
Do you have any children or dependents to file?
*
Yes
No
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Dependents
Should only be listed if you take care of the dependent over half of the year
Image of Dependent's S.S.Card
*
Choose Files
Upload ALL here
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1. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Date Of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Do you want to enter another dependent?
*
Yes
No, all dependents are entered
2. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Date Of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Do you want to enter another dependent?
*
Yes
No, all dependents are entered
3. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Date Of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Do you want to enter another dependent?
*
Yes
No, all dependents are entered
4. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Date Of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Did you pay any child care expenses throughout the year ?
Yes
No
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Child and Dependent Daycare Expenses
If the provider is a person, enter the care provider's SSN
Child Name Amount Paid
*
First Name
Amount Paid
Provider Phone Number
*
-
Area Code
Phone Number
Provider
*
Name
Tax ID #/ SSN
Provider Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you want to enter another child care provider?
*
Yes
No
Child Name Amount Paid
*
First Name
Amount Paid
Provider
*
Name
Tax ID #/ SSN
Provider Phone Number
*
-
Area Code
Phone Number
Provider Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Upload photos of your W-2,1099,and ALL documents
Attach an image of all documents that can be used to assist your tax preparer with the preparation of your tax return.
Upload
Choose Files
Cancel
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Enter any additional information or comments that you would like the include for your tax preparer
If you did not file your tax return with us last year, we recommend that you upload a copy of your previous year's tax return
Choose Files
Optional but STRONGLY recommended
Cancel
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Do you owe from previous years?
Yes
No
I have not filed previous years
Please select the following years you are trying to file
2022
2021
2020
2019
Do you have a business that you would like to be included on your return?
*
Yes
No
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Business Owners Data Sheet
Schedule C
Name of Business
*
Employer ID Number
EIN
What is the legal structure of your business?
*
Choose One
Sole Proprietor
Partnership
Corporation
LLC
Non-Profit
Haven't Filed It
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Amount of business taxes paid throughout the year?
$
Business Income
All income receive during the fiscal year
Total Income
$
Business Expenses
Complete to the best of your ability. In each field enter the approximate amount you spent in each category.
Advertising
Social media, Flyers, Business Cards, etc
Contract Labor
An person or company paid to assist you
Insurance
(Other than health)
Interest
Mortgage, Loans, Credit Cards, etc.
Legal & Professional Services
Training, Conferences, Mentors, Lawyers, etc
Office Expenses
Software, postage, email, internet, and any operating expenses
Rent and Lease
Vehicles, Machinery, Equipment, Electronics, Accessories, etc.
Repairs and Maintenance
Supplies
Objects used to operate your business
Taxes and Licenses
Travel, Meals, and Entertainment
Airfare, Uber, Taxi, Lyft, Business Dining, Business Entertainment, and etc.
Utilities
Other Expenses
Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?
Attach any photos or documents that you want us to have on file.
Choose Files
Cancel
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E- Signature Below
*
By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (470)242-4106 or email Fbsscreening@gmail.com
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