Certified Tax Preparation Application 2024

In Partnership with DiverseCiti
Tax Preparation Application

(2023 Tax Season)
Select the Tax year you are filling. *
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widow(er)

Taxpayer Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
SSN*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Driver's License State or State I.D.*
Enter the issuing state of your current and valid drivers license.
Current Driver’s license or State I.D. number. *
Occupation

Taxpayer Questions*

	Yes/No
Are you a full time student?
Are you totally and permanently disabled?
Can you be claimed as a dependent on someone elses tax return?
Does you, your spouse, and/or your dependents have health insurance within 12 months last year?
Did you receive unemployment compensation last year?
Did you pay church tithes and offerings last year?
Do you owe the IRS?
Do you owe back child support?
Are you a victim of Identity Theft?(If yes, send letter of pin from IRS)
Did you receive letter 6491 from the IRS? (If yes, attach copy of letter)
Did you receive letter 6475 from the IRS? (If yes, attach copy of letter)
Do you receive SNAP benefits?
Do you receive housing assistance from a government agency?
Do you receive any governmental assistance?

Spouse Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SSN
Phone Number
Please enter a valid phone number.
Email
example@example.com
Current Driver's License State or State I.D.
Enter the issuing state of your current and valid drivers license.
Current Driver's License or State I.D.
Occupation

Taxpayer Questions

	Yes/No
Are you a full time student?
Are you totally and permanently disabled?
Can you be claimed as a dependent on someone elses tax return?
Does you, your spouse, and/or your dependents have health insurance within 12 months last year?
Did you receive unemployment compensation last year?
Did you pay church tithes and offerings last year?
Do you owe the IRS?
Do you owe back child support?
Are you a victim of Identity Theft?(If yes, attach copy of pin from the IRS)
Did you receive letter 6491 from the IRS? (If yes, attach copy of letter)
Did you receive letter 6475 from the IRS? (If yes, attach copy of letter)
Do you receive SNAP benefits?
Do you receive housing assistance from a government agency?
Do you receive any governmental assistance?

Dependents

Enter your Dependents here:

	Name	SSN	Date of Birth	Relationship	College (Yes/No)
1
2
3
4
5
6

Enter Childcare Provider(s) Information here:

	Provider Name	Address	City/State/Zip	SSN/Fed ID Number	Amount Paid
1.
2.
3.

Tax Related Questions
Employment Status (Check all that apply)*

EmployedUnemployedSelf-employed

Answer questions below*

	YES	NO
Are you contributing to a 401K or IRA?
Did you take money from your 401K or IRA?
Is this your first time opening a pre-tax account?
Have you bought and sold any stock?

How would you like to receive your tax refund?*
If you chose Direct Deposit, enter the name of your Banking Institution here:

Direct Deposit

	Direct Deposit Information
Routing #
Account #

Expenses
Please fill-in the information for the current tax year only.

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses
Additional comments

Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow Certified Tax Service to capture my sensitive data like personal id, government id, social security number (SSN), and other information and to use this information to file my 2021 tax return. I have read the terms and conditions and privacy policy of Certified Tax Service. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
The signature below must match what's on your driver's license or your application will be rejected.
Taxpayer Signature*

Clear
Provide full signature. This is a safe and secure platform.
Spouse Signature

Clear

TAX DOCUMENT UPLOAD

**IF YOU DO NOT HAVE THESE DOCUMENTS RIGHT NOW A LINK WILL BE SENT TO YOU LATER WHEN YOU HAVE THEM AVAILABLE. CLICK THE [SUBMIT] BUTTON NOW**
Your Full Name
Do not enter your name unless you are uploading your documents right now.
Upload a copy of your Drivers License or Identification Card

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Upload a copy of SSN Cards and Dependents SSN cards

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Upload a copy of your W2/1099 Forms

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Upload all letters from the IRS. (Child Tax Credit, Stimulus, Identity Protection Pin)

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Upload all other Income. (SS Income, Alimony, Stock Report, Unemployment Statement, 401k/IRA statements.

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Upload a copy of your Mortgage/Rent Statements

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Upload a copy of your Childcare Tax Form or a written letter from the Childcare provider.

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Upload a copy of your 2022 Tax Return and Form 1098T if it applies.

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SKIP NOW! I WILL UPLOAD MY DOCUMENTS LATER

CERTIFIED TAX SERVICE, LLC
LETTER OF ENGAGEMENT TO PREPARE TAX RETURN

The undersigned person(s) has authorized CERTIFIED TAX SERVICE (CTS) or any authorized representative of CTS to prepare their federal and/or state tax return(s) CTS claims no responsibility for the tax return(s) other than preparing the said return(s) The accuracy of the return(s) will be directly related to the information that you, the taxpayer(s), provide CTS or any authorized representative of CTS. The information received by CTS will be used in compliance with the rules and regulations of the Internal Revenue Service.

Two forms of identification such as a social security card or a form with picture identification should be presented to the preparer during services. You must provide our office with the appropriate documents such as a W-2, 1099, 1098, childcare information, college student, mortgage information, etc., for your tax return to be properly e-filed to the IRS. We will supply you with a copy of your tax return and advise you to keep it in a safe and secure place in case it is needed. We will not be able to provide you with another copy once the office has closed for the tax season. You will have to contact the IRS to receive additional copies at that time.

In the event of an electronic filed tax return refund, anticipated loan, etc., CTS makes no claim or guarantees regarding the time for expected delivery. All dates and/or responsibility LETTER OF ENGAGEMENT TO PREPARE TAX RETURN is limited to the preparation of the return for electronic transmission. After electronic transmission, any delays caused by the IRS, Bank(s) and/or any other government agency involved are not the responsibility of CTS.

By signing this Letter of Engagement, to prepare your Tax Return(s), you have agreed to fully compensate and authorize CTS to prepare your tax return(s For payment of services rendered, it is to be electronically deducted from your refund. The taxpayer(s) is/are fully responsible for any unpaid balance. Any outstanding balance must be paid in full during the time of services rendered. The taxpayer(s) will be responsible for any and all fees and expenses, including collection, attorney fees, damages, court cost and interest that may incur in CTS collecting the unpaid debt. CTS will have the right to report to any Credit Reporting Agency using any information provided.
Date*

MonthDayYear
Date
Your Full Name*
Your signature must match what is on your driver's license.
Primary Tax Payer Signature

Clear
Spouse Signature

Clear
Should be Empty:

In Partnership with DiverseCiti

Tax Preparation Application

TAX DOCUMENT UPLOAD

CERTIFIED TAX SERVICE, LLC