Mysaiah Inc. Tax Preparer

Time to file your taxes let's gooooo!

Email: mysaiahinc@gmail.com - Cell: 708-205-3605 - Office: 888-217-7651 - Fax: 888-216-4419
Please note that if this is my first time filing your taxes with us, please email your previous taxes to mysaiahinc@gmail.com or fax to 888-217-4419

Thank you!
Date

MonthDayYear
Date
How did you hear about us?

ReferralPrevious Client
What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouse
If someone referred you, please type his or her name here.
How are you filing your taxes this year?

Single (not married)Married filing JointlyMarried filing SeparateHead of the household
What is the best day & time to contact you?
Did you file your taxes last year?

YesNoUnsure
What was your AGI on your last filed tax return? (Adjusted Gross Income)
This is very important, and will be needed before the return can be completed. Please email your previous year return to mysaiahinc@gmail.com.
Are you trying to buy a new home within the next 2 years?

YesNo
Taxpayer's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address*
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Name

First NameLast Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Taxpayer's SSN
Example: xxx-xx-xxxx
Spouse's Job Title
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you self employed?*

YesNo
Did you and your spouse live apart during the year?*

YesNoNot Applicable
Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo
Did you support a child or family member for more than 6 months out of the year?*

YesNo
If yes, did you live together at any time after June 30, 2022*

YesNoNot Applicable
Are you on any Government Assistance*

YesNoNot Applicable
How many dependents are you claiming?*
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2020? (If all year, enter 12)
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
Dependent #2s SSN
Example: xxx-xx-xxxx
How many months did Dependent #2 live with you in 2020? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2020? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2020? (If all year, enter 12)
Dependent #5's First Name
First Name
Dependent #5's Last Name
Last Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's SSN
Example: xxx-xx-xxxx
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2020? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here. or take a photo below.

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How would you like to receive your tax refund?

Check (Only available for in office visits)Direct Deposit
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Can someone else claim you as a dependent?

YesNo
Did you have health insurance in 2020?

YesNo
Did you have health insurance for the entire year?

YesNo
Who was your insurance coverage through in 2022?
Was your insurance through your employer?

YesNo
Was your insurance through Medicaid?*

YesNo
Was your insurance through the Affordable Care Act (The Marketplace)?*

YesNo
Did your dependents have health insurance for the entire year?

YesNoNot Appliable
Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable
Who was your Dependents insured with in 2022?
Upload Taxpayer & Dependent(s)Insurance Documents

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Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

YesNoNot Applicable
Have you ever been denied the Earned Tax Credit (EITC)?

YesNo
Did you receive the first round of stimulus check?*

YesNo
Did you receive the second round of stimulus check?

YesNo
Have you ever been denied the Earned Tax Credit (EITC)?

YesNo
Please list the kind of vehicle you drove last year.
Please list the kind of vehicle your (Spouse)drove last year.
Were you or any of your dependents in college in 2020?

YesNo
Did you trade any Virtual Currency

YesNo
Do you have a 1098-T Form for either you or your dependents?

YesNo
If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?

YesNo
ADDITIONAL SERVICES

At Mysaiah Inc, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you at a later time.
Primary Taxpayer's Signature

Clear
Other services we provide.

Business Taxes1099's for employeesBusiness ManagementTax ID number for your businessIncorporation & annual renewalsIncorporation reinstatement $350LogisticsDOT & MC# Includes BOC-3 & UCR (Box truck $700-Tractor $850Truck InsuranceAnnual UCRPayroll for yourself & employees with direct deposit2290'sDispatchingNotary Public Georgia & Mississippi (only)Clergy Officiant services (Marriage Ceremonies all 50 states in person or virtual ($100 and up)Agent for your trucking company (dispatching-Truck insurance-bobtail insurance-we provide tags etc. lets talkTrucking Company Authority, MC# & DOT# included ($1000)
Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S/

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Only as it applies: Self-Employment Expense Log, Summary if Income, Business License, Bank Statements, receipts, etc

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

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Healthcare Card for Taxpayer(s) and Dependent (s)

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Type a question
Date

MonthDayYear
Date
Taxpayer's Signature (If no spouse, leave blank)

Clear
Date

MonthDayYear
Date
Spouse's Signature (If no spouse, leave blank)

Clear
Should be Empty:

Time to file your taxes let's gooooo!

Please note that if this is my first time filing your taxes with us, please email your previous taxes to mysaiahinc@gmail.com or fax to 888-217-4419