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Emerald Data Form- ETS
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49
Questions
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1
Do you require assistance for previous tax years other than the current year?
*
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YES
NO
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2
Do you have ALL of your tax documents? Keep in mind we CANNOT submit your return until all documents have been received by our office
*
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YES
NO
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3
Here’s a checklist of most documents that we need to submit your Tax Return
*
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Healthcare Forms (Entire Household) if applicable Proof of Dependent (Shot Record/Birth Certificate)
Proof of Residence (Lease Agreement/Utility Bill)
Social Security Cards(Entire Household)
Valid Driver’s License Form 6475 (Stimulus)
Form 6419 (Advance Child Tax Credit) Form 1098 (Mortgage Interest)
Form 1098-T (provided by school) 2021 Tax Return (if available)
W2/1099/Self Employment Expense Log or Summary of Income, Business License, Bank Statements, Receipts, etc
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4
Primary Full Name
*
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First Name
Last Name
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5
Phone Number
*
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Please enter a valid phone number.
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6
Cell Phone Provider
*
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7
Email
*
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example@example.com
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8
For Verification & Security purposes, please take a clear picture of yourself and upload it here.
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: 10.6MB
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9
Upload your Drivers license / Identification card
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10
Primary Taxpayer Social Security Number
if this do not apply to you please disregard
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11
Upload your Spouse Social Security Card
if this do not apply to you please disregard
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: 10.6MB
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12
Were you married as of 12/31?
YES
NO
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13
Spouse Full Name
if this do not apply to you please disregard
First Name
Last Name
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14
Spouse’s Contact Number
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15
Spouse Date Of Birth
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16
Spouse Social Security Number
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17
Upload Spouse Social Security Card
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18
Address
*
This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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19
Do you own or rent?
YES
NO
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20
Upload Mortgage Interest Statement (Form 1098), if you own
if this do not apply to you please disregard
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21
Do you have any dependents to claim
YES
NO
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22
If yes, please list dependents name, date of birth, ssn, gender, relationship.
if this do not apply to you please disregard
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23
Upload Social Security Card(s) for each dependent
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24
Are you required to file taxes using an Identity Protection PIN (IPPIN)?
YES
NO
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25
Upload Identity Protection PIN letter
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26
Did you receive unemployment compensation during 2022?
YES
NO
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27
Upload Form 1099-G
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28
Were you employed during 2022?
YES
NO
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29
Upload W-2(s)
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30
Did you attend college?
YES
NO
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31
Upload 1098 T
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32
Did you or anyone in your household receive Health Insurance through the Healthcare Marketplace?
YES
NO
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33
Upload 1095A
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34
Were you self-employed during 2022?
YES
NO
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35
If you have your income and expense totals, please upload them here. If not, we will send you a document requesting this information
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36
Did you or anyone in your household receive SSI ?
YES
NO
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37
Upload SSA-1099
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38
Do you owe any State or Federal Agencies that may cause an offset to your refund? (ie Child Support, Unemployment Repayment, Federal or State Taxes)
YES
NO
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39
Did you receive the FIRST stimulus payment? If yes, please list amount
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40
Did you receive the SECOND stimulus payment? If yes, please list amount
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41
Did you receive the THIRD stimulus payment? If yes, please list amount
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42
Did you receive Advance payments in 2021? If yes, how much was your Advance payments?
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43
Upload Form 6419
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44
Would you like to apply for a Refund Advance Loan?
*
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YES
NO
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45
How would you like to receive your refund?
*
This field is required.
Direct Deposit
Check
Direct Deposit
Check
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46
Upload Voided Check or Account & Routing numbers.
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47
How will you pay your tax prep fees?
*
This field is required.
Refund Transfer (taken from your refund)
Out of Pocket
Refund Transfer (taken from your refund)
Out of Pocket
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48
Who Referred You?
*
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49
By signing you agree to our client non payment/ offset clause.
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