2022 TAX INTERVIEW

2023 TAX INTERVIEW
INDIVIDUAL TAXBUSINESS TAX

INDIVIDUAL TAX INTERVIEW
Social Security Number:   123456789*

Full Name:   First Name*   Middle      Last Name*   Suffix

Date of Birth:   01/01/2000*

Occupation:   Nurse Practitioner*

Cell Phone:   123*   123-4567*

Phone Number (Day):   123   123-4567

Phone Number (Evening):   123   123-4567

Email Address:   john@gmail.com*

Are you a dependent of another?    Yes    No

Are you blind/disabled?    Yes    No

Are you an active-duty military?    Yes    No

Filing Status:*

SingleMarried - Filing JointlyMarried - Filing SeparatelyHead of HouseholdQualifying Widower

Spouse:
Social Security Number:   123456789

Full Name:   First Name   Middle      Last Name   Suffix

Date of Birth:   01/01/2000

Occupation:   Nurse Practitioner

Cell Phone:   123   123-4567

Phone Number (Day):   123   123-4567

Phone Number (Evening):   123   123-4567

Email Address:   jane@gmail.com

Are you a dependent of another?    Yes    No

Are you blind/disabled?    Yes    No

Are you an active-duty military?    Yes    No

Personal Details:
Address:*
Apartment Number:
City:*
State:*
Zip Code:*
Do you have any dependent(s)?*

YesNo

Is this your own child?*

YesNo

Schedule EITC (Earned Income Tax Credit)
If the relationship is other than the son or daughter, the information below must be provided:

Birth Certificate (Verify relationship)
Medical Records (Immunization Record not eligible)
Proof of Residency (6 months)
School Records (Formal School Letter with Letterhead)
First Child Name:   First Name*   Last Name*   Suffix

Child Relationship:   Grandchild*

Birth Date:   01/01/2000*

Social Security Number:   123456789*
Please Upload Records:

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Second Child Name:   First Name   Last Name   Suffix

Child Relationship:   Grandchild

Birth Date:   01/01/2000

Social Security Number:   123456789
Please Upload Records:

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Third Child Name:   First Name   Last Name   Suffix

Child Relationship:   Grandchild

Birth Date:   01/01/2000

Social Security Number:   123456789
Please Upload Records:

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Why are the parent(s) not claiming the child as a dependent?*
Are any of your children foster/adoption?*

YesNo
Brother, Sister, Niece, Nephew, Grandchildren, Great-Grandchildren:
Can you provide a Birth Certificate that verifies relationship to the child?*

YesNo
Please Upload Birth Certificate:

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Stepchildren, Stepbrother, Stepsister:
Can you provide a Birth Certificate and Marriage Certificate for relationship verification to the child?*

YesNo
Please Upload Birth Certificate/Marriage Certificate:

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To the best of my knowledge, I confirm the information I am providing to "Robert Anderson Tax" and "IRB.TAX" is accurate and is supported by any necessary document(s) require by law.

I declare under penalty of perjury that the foregoing is true and correct.
Print Name:*
Signature*

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Date*

MonthDayYear

Do you have any more dependents?*

YesNo

Dependent 1:
Can another person claim your child as a dependent or receive EIC for this child?

YesNo
Full Name:   First Name   Last Name

Date of Birth:   01/01/2000

Social Security Number:   123456789

Month(s) in home:   6

Relationship:
Please Upload:

1. Dependent's Birth Certificate

2. Dependent's Proof of Address
File Uploads:

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Is the child disabled?

YesNo
Do you have a second dependent?*

YesNo

Dependent 2:
Can another person claim your child as a dependent or receive EIC for this child?

YesNo
Full Name:   First Name   Last Name

Date of Birth:   01/01/2000

Social Security Number:   123456789

Month(s) in home:   6

Relationship:
Please Upload:

1. Dependent's Birth Certificate

2. Dependent's Proof of Address
File Uploads:

Cancelof
Is the child disabled?

YesNo
Do you have a third dependent?*

YesNo

Dependent 3:
Can another person claim your child as a dependent or receive EIC for this child?

YesNo
Full Name:   First Name   Last Name

Date of Birth:   01/01/2000

Social Security Number:   123456789

Month(s) in home:   6

Relationship:
Please Upload:

1. Dependent's Birth Certificate

2. Dependent's Proof of Address
File Uploads:

Cancelof
Is this child disabled?

YesNo
Do you have a fourth dependent?*

YesNo

Dependent 4:
Can another person claim your child as a dependent or receive EIC for this child?

YesNo
Full Name:   First Name   Last Name

Date of Birth:   01/01/2000

Social Security Number:   123456789

Month(s) in home:   6

Relationship:
Please Upload:

1. Dependent's Birth Certificate

2. Dependent's Proof of Address
File Uploads:

Cancelof
Is this child disabled?

YesNo
Can another person qualify to claim your child as a dependent or receive EIC for this child?
Qualifying childcare expenses Incurred and Paid

Please answer to the best of your knowledge:
Are you employed?*

YesNo
If Yes, is your W2 ready?*

YesNo
File Upload your W2

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Or take a picture of your W2
Did you receive unemployment?*

YesNo
Please Upload your EDD/1099-G

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Or take a picture of your EDD/1099-G
Did anyone attend college during the tax year?*

YesNo

Student Acknowledgement / Education Credit & Deductions
Who attended college?*

TaxpayerSpouseDependent
Student Name*
Please Upload your 1098-T Form:

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To the best of my knowledge, I confirm the information I am providing to "Robert Anderson Tax" and "IRB.TAX" is accurate and is supported by any necessary College Document(s) require by law.

I declare under penalty of perjury that the foregoing is true and correct.
Print Name:*
Signature*

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Date*

MonthDayYear

Are you self-employed?*

YesNo

DECLARATION OF SELF-EMPLOYMENT INCOME

(Schedule C Due Diligence)
I, First Name* Last Name* declare the following:

Profession:   Painter*

Business Name:   ABC Complany*

Federal Identification Number (If applicable):   123456789

Date:   Date

Did you keep records of Business income and expenses?    Yes    No*
Please Upload your Profit & Loss (Income & Expense) Report:

Cancelof
Please Upload any 1099-MISC/NEC:

Cancelof
Business Expense Worksheet
Advertising Expense:

Office Expense:

Car Expense/Mileage:

Insurance:

Rent/Vehicle/Equipment:

Rent/Other:

Commission/Fees:

Supplies:

Taxes/License(s):

Travel Expense(s):

Employee Wage(s) Paid:

Utilities:

Meals/Entertainment:

Mortgage interest:

Prior Depreciation:

Repairs/Maintenance:

Contractor Labor/Wages Paid:

Other:

Days on the road (i.e. truck driver):

(Specify):

Office in home - Total square footage of home:
To the best of my knowledge, I confirm the information I am providing to "Robert Anderson Tax" and "IRB.TAX" is accurate and is supported by any necessary document(s) require by law.

I declare under penalty of perjury that the foregoing is true and correct.
Print Name:*
Signature:*

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Date:*

MonthDayYear

Do you have any delinquencies?
Child support?

YesNo
Alimony?

YesNo
Student loan(s)?

YesNo
Back taxes?

YesNo

Additional Information:
Would you like to add any notes:
Upload any (Tax related) miscellaneous files:

Cancelof

Refund Options:
IF you get a refund, how would you like to receive it?*

CHECK (Mailing Address)DIRECT DEPOSIT
Routing Number
Account Number

BUSINESS Information
Business Address:*
Business Website:
Contact phone number:*
Fax phone number:
Email Address:*
Upload Filing Year Financials:

Cancelof
Upload a Copy of your Latest Business Tax Filing:

Cancelof
Upload Any Additional Supporting Document(s):

Cancelof

Confirmation:
To the best of my knowledge, I confirm the information I am providing to "Robert Anderson Tax" and "IRB.TAX" is accurate and is supported by any necessary document(s) require by law.

I declare under penalty of perjury that the foregoing is true and correct.
Print Name:*
Company Role:
Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
Should be Empty:

2023 TAX INTERVIEW

INDIVIDUAL TAX INTERVIEW

Spouse:

Personal Details:

Schedule EITC (Earned Income Tax Credit)

Brother, Sister, Niece, Nephew, Grandchildren, Great-Grandchildren:

Stepchildren, Stepbrother, Stepsister:

Dependent 1:

Dependent 2:

Dependent 3:

Dependent 4:

Please answer to the best of your knowledge:

Student Acknowledgement / Education Credit & Deductions

DECLARATION OF SELF-EMPLOYMENT INCOME

Business Expense Worksheet

Other Income:

Capital Gains - Sell of Assets:

Please answer to the best of your knowledge:

Do you have any delinquencies?

Additional Information:

Refund Options:

BUSINESS TAX INTERVIEW

BUSINESS Ownership

BUSINESS Information

Confirmation: