INDEX TAX & FINANCIAL, INC

INDEX TAX & FINANCIAL, INC 美国长越财务会计

923 E Valley Blvd, Ste 111 & 107, San Gabriel, CA 91776 - Phone: 626-288-0830
Name 客户姓名
SSN 社安号
Birthdate 生日*

MonthDayYear
Date
Phone 电话*
Email
example@example.com
Wechat (if any) 微信
Address 地址
PART 2
Legal status

US Citizen 公民Greencard holder 绿卡EAD 工卡H1BOther
Filing status

Single 单身Head of Household 户主Married Filing Jointly 已婚联合报税Married Filling Separately 已婚分开报税Other

Income 收入
*W2 Income 薪资
Self-Employment *1099 自雇收入
1099 Job 职业
Interest Income *1099 INT 银行存款利息
Stock *1099B 股票
Unemployment *1099G 失业金
Retirement *SSA-1099 退休金
Gambling Income *W2G 赌博
Rental Income 房屋出租
Company Dividend *K1 公司分红
Selling of Property *1099S 房屋买卖
Virtual Currency Transactions 虚拟货币交易
Other Income (Please list) 其他收入（请注明）
Deductions 可抵税项目
Property Tax 自住房地税税单
Mortgage *1098 房屋贷款
Tuition *1098T 学费
Children Daycare Expense 子女日托费用
Donations 捐款
Retirement Contributions 退休账户
Out-of Pocket Medical Bills 自付医药费(账单)
Other Expenses (Please list) 其他支出（请注明）
Insurance 保险
Type a question

Insurance Obamacare *1095A 奥巴马保险Other Insurance *1095B 其他保险Employer-Sponsored Insurance*1095C 公司保险No Insurance 无保险
Have you ever applied for EIDL loans? 请问是否申请过EIDL贷款？

YesNo
Taxpayer Signature 确认以上报税资料准确无误后请签字，并提供个人身份证复印件

Clear
Date

MonthDayYear
Date
DISCLAIMER: THIS INFORMATION CHECKLIST IS WRITTEN SOLELY BASED ON DOCUMENTS PROVIDED BY THE CLIENT. WHICH HAVE NOTBEEN VERIFIED. INDEX TAX & FINANCIAL, INC DOES NOT HOLD ANY LIABILITIES FOR ANY SUBSEQUENT EVENTS.
Last year tax return and ID

Cancelof
Should be Empty:

Income 收入