Jay Talk Tax

Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
Social Security #
Occupation
Marital Status
Email
example@example.com
Will you be claimed as a dependent on someone else's tax return?
Spouse Information

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Email
example@example.com
Social Security #
DEPENDANT INFORMATION
Did you file a 2023 Tax Return ?
Have you received a letter or notification from the IRS in the past 3 years?
Did you or anyone you're claiming receive insurance through Marketplace? (If yes, provide 1095-A form, tax return cannot be processed without it)
Have you received unemployment at any time during the current tax year?
Are you planning to purchase a home within the next year?
Which Tax Documents do you need to file?
Will you be claimed as a dependent on someone else's tax return?

Other
Bank Name
Account Type (Checking/Saving)
Mailing Address
Routing Number
Account Number
This firm and its employees will comply with all of the provisions of the Revenue procedure for electronic filing or individual and business income tax returns, and related publications for each year of our participation.

Under the penalty of perjury. I/We declare that I/We have read and examined this application and accompanying information, and hereby certify that the information being provided above is true, complete. correct and accurate to the best of my/our knowledge and belief.
Customer Signature
Date

MonthDayYear
Date
Spouse Signature
Date

MonthDayYear
Date
I hereby certify that the return was prepared with information provided to me by the Taxpayer whose signature appears above.

If fraud is suspected, I will notate the file and take necessary action.
Tax Return prepared by
Preparer's Signature
Date

MonthDayYear
Date
UPLOAD ALL TAX DOCUMENTS W2, DRIVERS LICENSE, SOCIAL SECURITY CARDS, ECT.

Cancelof
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