2023 Central Florida Tax Pros Information Request Form

HOW DID YOU HEAR ABOUT US:

SOCIAL MEDIAWALK INGOOGLEOTHER: ______________________

Cash Advance *

Tax Year Filing *

Filing Status:*

Name *

First NameMiddle NameLast NameSuffix

SSN*

Date of Birth *

Date

Phone Number*

Driver License Number*

Email*

example@example.com

Spouse Name

First NameLast NameSuffix

SSN

Date of Birth

Date

Phone Number

Driver License/ ID Number

Spouse Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If any of your dependent didn't live with you in 2023, please let your preparer know...

Dependent 1:

First, Last

SSN

Date of Birth

Dependent 2:

First, Last

SSN

Date of Birth

Dependent 3:

First, Last

SSN

Date of Birth

Dependent 1 relationship:

Dependent 2 relationship:

Dependent 3 relationship:

If Claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/ dependents?

If your dependent is over the age of 18 and disabled, what is the nature of the disability?

Does the dependent receive social security/disability benefits?

Are you listed as the Social Security Representative Payee for this dependent?

In case your contact information change or in case of an emergency:

Name, Phone Number

Complete Only if Your Filing an Dependent

Earned Income (EIC) Eligibility

If you have an Identity Protection list below.

You may claim the EIC if you answer Yes to all 4 tests below (See publications 17, Chapter 36)

Relationship Test: 1. Your child/children is/are one of the following: A son, daughter, adopted child, stepchild, grandchild, or eligible foster child, or is your brother, sister, stepbrother, or stepsister), and you care for them as you would your own.

Can someone else claim you or your dependent on their tax return?*

YESNO

ARE YOU ON ANY GOVERMENT ASSISTANCE?*

YESNO

Do you or your spouse owe the IRS?*

YESNO

Do you owe back child support?*

YESNO

Did you or your dependents have Marketplace in 2023?*

YESNO

Did you live a the above listed address for more than 6 months?*

YESNO

Did you receive unemployment compensation income?*

YESNO

Did you or your dependent attend college?*

YESNO

Do you have a 1098-T form from your or your dependent college?*

YESNO

Are you currently paying or owe student loans?*

YESNO

How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Money Card

Name / Childcare Name

Childcare Address

Childcare EIN / SSN

FRONT: ID/ Driver License *

BACK: ID/ Driver License *

Spouse FRONT: ID

Spouse BACK: ID

Taxpayer Social Security Card *

Dependent #1 Social Serurity Card

Dependent #2 Social Security Card

Dependent #3 Social Security Card

Income/ W2/ 1099

Marketplace/ 1095-A

Other Docs:

Can you the taxpayer provide school, medical, daycare, place of worship, / birth certificates upon request from the government?

Signatures: By signing below you represent that everything you stated in the above area is true and correct. You respresent that you have read and understand the questions asked and conditions herein. You will acknowledge receving a completed copy of this complete application, among other things, consent the collection authorization in the above information.

I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing On Time Taxes to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email info@centralfloridataxpros.com

IRS Contact 800-829-1040

Please check the irs site for your -federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

Name*

First NameLast Name

Date*

Date

Signature*

OFFICE USE ONLY:

FORM OF COMMUNICATION:

IN PERSONPHONEVIRTUALOTHER

Dependant Information

Child Care Provider

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