CLIENT INFORMATION FORM
For 2023 Tax Year
Are you a US citizen?
*
Yes
No
Taxpayer Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Spouse Name
First Name
Middle Name
Last Name
Spouse Date of Birth
-
Month
-
Day
Year
Date
Occupation
*
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Can someone else claim you on their taxes?
*
Yes
No
Were you married at the end of 2023?
Please Select
Yes and we lived together
Yes, but we lived separately
No
Did you have insurance last year?
*
Yes, from my employer
Yes, from the Marketplace
Yes, I had Medicaid
No insurance
Did you work for a rideshare or delivery service in 2022? For example Uber, Lyft, Door Dash, Amazon Flex, etc.?
No
Dependent Info: For each dependent, enter Name, Date of Birth, Relationship
Signature
*
My signature indicates that the information I provided above is true and accurate
Submit
Should be Empty: