What year(s) are you filing 2017201820192020
Taxpayer's ss# Number* DOB Date DL# Number* State Please Select AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ISS Date Date EXP Date Date Occupation Phone Area CodePhone Number
First NameLast Name SSN# Number DOB Date Relationship Please Select Daughter Son Niece Nephew Tuition/dependent care $ Number Disabled YesNo
First NameLast Name SSN# Number DOB Date Relationship Please Select Daughter Son Niece Nephew Tuition/dependent care $ Disabled YesNo
I Hereby certify that the information provided on this form is correct to the best of my ability and therefore authorize The Tax Lady(Linda Brimley) to prepare and/or electronically file my Tax Return.