TAXPAYER APPLICATION w/Self Employed

Thank you for allowing us to prepare your tax return. It is very important for you to complete the application below to help our tax preparer complete an accurate tax return. If you have any questions, please ask. Please review and complete the entire form and also provide us with the additional items we need below to complete your tax return.

Tax information such as W-2s, 1099s, 1098s.

Social security cards or a letter from the SSA for you and all persons on your tax return.

Proof of Identity (such as current Driver's license or State ID

Part I. Your Personal Information 1. Your First Name

1. Your First Name

MIDDLE INITIAL

Last Name

Social Security No.

2. Spouse's First Name

M.I.

Last Name

Social Security No.

3. Mailing Address

Apt#

City

State

Zip Code

4. E-mail

example@example.com

HOME PHONE

CELL PHONE

5. Your Date of Birth

Date

6. Your Occupation

7. Are you Legally Blind

YESNO

8. Spouse's Date of Birth

Date

9. Spouse's Occupation

10. Is Spouse Legally Blind?

YESNO

11. Can your parents or someone else claim you or your spouse on their tax return?

YESNO

Part II. Family and Dependent Information

1. As of December 31, 2025 your marital status was: (Check answer)

SINGLEMARRIED

Married: Did you live with your spouse during any part of the last six months of 2025?

YESNO

2. List the names of everyone below who lived in your home that you supported during the past 12 Months.

Do not enter your name or Spouse's name below.

DEPENDENTS FIRST AND LAST NAME

DATE OF BIRTH (M/D/Y)

SOCIAL SECURITY NUMBER

ENTER THE NUMBER OF MONTHS LIVED IN YOUR HOME FOR 2025

Relationship to you (i.e. son, daughter, mother, sister)

FIRST AND LAST NAME

DATE OF BIRTH (M/D/Y)

SOCIAL SECURITY NUMBER

NUMBER OF MONTHS LIVED IN YOUR HOME FOR 2025

RELATIONSHIP TO YOU

FIRST AND LAST NAME

DATE OF BIRTH (M/D/Y)

SOCIAL SECURITY NUMBER

NUMBER OF MONTHS LIVED IN YOUR HOME FOR 2025

RELATIONSHIP

FIRST AND LAST NAME

DATE OF BIRTH (M/D/Y)

SOCIAL SECURITY NUMBER

NUMBER OF MONTHS LIVED IN YOUR HOME FOR 2025

RELATIONSHIP TO YOU

FIRST AND LAST NAME

DATE OF BIRTH (M/D/Y)

SOCIAL SECURITY NUMBER

NUMBER OF MONTHS LIVED IN YOUR HOME FOR 2025

RELATIONSHIP TO YOU

Rental Assistance (check one that applies to you)

Privately owned subsidized housingPublic HousingHousing Choice Voucher Program (Section 8)Live with someone

Part III. Income - In 2025, did you (or your spouse) receive:

(Check Yes or No to all questions below)

1. Wages (W-2 Employee) or Salary

YESNO

2. Self-Employment Income (such as earnings from contract labor and small business, etc.)

YESNO

3. Did you receive a 1099 MISC form?

YESNO

4. Disability Income If so, what is the amount?

YESNO

Total Disability Income

5. Unemployment Compensation If so, how much did you receive?

YESNO

Total Unemployment Income

6. Other Income: (gambling, lottery, prizes, awards, jury duty, etc

YESNO

7. Contributions to IRA, 401 k, or other retirement account, including employer retirement account

YESNO

8. Do you own your home? If yes, include mortgage statement interest and taxes.

YESNO

Mortgage Interest

Property Taxes

9. Do you pay child care expense (Daycare or an individual to baby sit your children) If yes, how much was your child care expense from January 1, 2025 to December 31, 2025?

YESNO

CHILD CARE AMOUNT

Name of Daycare/Individual

SSN or EIN Number

Address

City

State

Zip Code

10. Do you pay a HEAT BILL out of pocket?

YESNO

If yes, how much did you pay from January 1, 2025 to December 31, 2025?

Name of Company you paid your heat bill too

11. Do you rent your home? If yes, identify landlord and address and monthly rent.

YESNO

If yes, identify landlord and address and monthly rent.

Landlord Name

Address

City

State

Zip Code

Part VI. Schooling - In 2025 Did you (or your spouse):

1. Pay college tuition for yourself, your spouse, or your dependents for the 2025 Tax Year?

YESNO

2. Did you have any educational expenses this year (Such as a computer, books, etc?

YESNO

3. Did you pay on a student loan this year?

YESNO

Part V. Referral - Please check one of the following below:

How did you hear about us?

Church

YESNO

Name of Church

Flyer/Door Hanger

YESNO

Radio

YESNO

Name of Radio Station?

REFERRED

YESNO

Relative/Friend - Please write first and last name of referrer

Returning Client

YESNO

Other

Consent to Use of Tax Return Information

Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2025 tax return to determine whether to present you with the opportunity to apply for these products and services and you attest under penalty of perjury that the above information is true.

Printed name of Taxpayer

Taxpayer Signature

Date

Printed Name of Joint Taxpayer

Joint taxpayer Signature

Date

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TAX PAYER APPLICATION