EXXACT TAX CLIENT QUESTIONNAIRE

Name

First NameMiddle NameLast Name
SUFFIX:
MARITAL STATUS
SOCIAL SECURITY #
DATE OF BIRTH:

MonthDayYear
Date
AGE:
OCCUPATION:
PHONE NUMBER
Please enter a valid phone number.Format: (000) 000-0000.
CELLPHONE CARRIER (ex.T-Mobile, AT&T, Verizon)
RECEIVE TEXTS:
EMAIL ADDRESS:
example@example.com
ADDRESS:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IS THERE ANYONE ELSE AT THIS ADDRESS WHO CAN FILE HEAD OF HOUSEHOLD?
DID YOUR ADDRESS CHANGE?
OTHER ADDRESS USED (IF APPLICABLE)
DID YOUR MARITAL STATUS CHANGE IN 2022?
DID YOU RECEIVE OR REQUEST A 6 DIGIT IDENTITY PROTECTION NUMBER PIN FROM THE IRS?
SPOUSE INFORMATION(IF APPLICABLE):

First NameMiddle NameLast Name
SUFFIX:
SOCIAL SECURITY #
DATE OF BIRTH:

MonthDayYear
Date
AGE:
OCCUPATION:
PHONE NUMBER
Please enter a valid phone number.Format: (000) 000-0000.

DEPENDENTS: