Tax Estimate Request Form
Precision Tax & Notary Services
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
First Name
Last Name
Date of birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
W2(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
In 2023, Did you receive any government assistance?
Yes
No
Spouse Information
Name
First Name
Last Name
Occupation
W2(s)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you receive a federal tax last year?
Yes
No
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Precision Tax & Notary to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
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