TAX PREPARATION FORM

Client Tax Data Sheet

Fill out the form below to submit your tax information to me. If you have any questions prior to completing this form, do not hesitate to contact me by email denise.murray@ubellc.net or by phone at (800) 672-1980. Thank you and have a great day!
NEW or Returning Client

New ClientReturning Client
If your a NEW CLIENT, How did you hear about us or who referred you?
First Name*
Middle Name
Last Name*
Suffix
Jr, Sr, II, III
Social Security Number*
Date of Birth*

MonthDayYear
Date
Occupation*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Social Sec. Card & Driver's License *

Choose File
Identification Cancelof
What is your filing status?*
Are you filing an eligible spouse on your tax return?*

YesNo

Spouse Name

First NameMiddle NameLast NameSuffix
Social Security Number
Occupation
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #
State Driver's License Was Issued
Date Driver's License Was Issued
MM/DD/YYYY
Driver's License Expiration Date
MM/DD/YYYY
Photo of Driver's License

Choose File
Identification Cancelof

Dependents

Should only be listed if you take care of the dependent over half of the year
Image of Dependent's S.S.Card

Choose Files
Upload ALL here Cancelof
1. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?

YesNo, all dependents are entered
2. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?

YesNo, all dependents are entered
3. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?

YesNo, all dependents are entered
4. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Did you pay any child care expenses throughout the year ?

YesNo

Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN
Child Name
Dependent First and Last Name
Amount Paid to Provider
Total amount paid for the year
Provider Name
Provider Phone Number

Area CodePhone Number
Provider EIN or SSN
Employer Identification Number or Social Security Number
Provider Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you want to enter another child care provider?

YesNo
Child Name
Dependent First and Last Name
Amount Paid to Provider
Total amount paid for the year
Provider Name
Provider EIN or SSN
Employer Identification Number or Social Security Number
Provider Phone Number

Area CodePhone Number
Provider Address

Street Address

Street Address Line 2

CityState

Zip Code

Business Owners Data Sheet

Schedule C
Name of Business
What is your business PROFESSION or SERVICE?
Employer ID Number
EIN
What is the legal structure of your business?
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount of business taxes paid throughout the year?
Business Income

All income receive during the fiscal year
Total Income
Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.
Advertising
Social media, Flyers, Business Cards, etc
Dues and Subscriptions
Annual Amount
Charity
Contract Labor
Person or Company you paid over $600
Insurance
(Other than health)
Interest
Mortgage, Loans, Credit Cards, etc.
Legal & Professional Services
Training, Conferences, Mentors, Lawyers, etc
Office Expenses
Software, postage, email, internet, and any operating expenses
Rent and Lease
Vehicles, Machinery, Equipment, Electronics, Accessories, etc
Repairs and Maintenance
Shipping/Postage
Supplies
Objects used to operate your business
Taxes and Licenses
Telephone Expense Amount
Utilities
Meals and Entertainment
Business Dining, Business Entertainment, and etc.
Travel
Airfare, Uber, Taxi, Lyft, Hotel, and etc
Auto Expenses
Auto Year, Make and Model
Auto Purchase Price
Auto Mileage
Amount for the YEAR
Auto Gas/Fuel
Amount for the YEAR
Auto Repairs and Maintenance
Amount for the YEAR
Auto Parking Fees and Tolls
Amount for the YEAR
Auto Insurance
Amount for the YEAR
Auto Lease Payments
Amount for the YEAR
Auto Interest Expense
Amount for the YEAR
Auto Ad Valorem
Amount for the YEAR
Home Office Expenses
Square Foot Home Office Space
Square Foot of Entire Home
Assets
List the Item, Date Purchased, Purchase Price and Usage
Other Expenses
Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?
Attach any photos or documents that you want us to have on file.

Choose Files

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E- Signature Below*

Clear
By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (678)562-1549 or email ContactUs@CollinsFSG.com
Should be Empty:

Client Tax Data Sheet

Payment/Refund

Dependents

Child and Dependent Daycare Expenses

Upload photos of your W-2,1099,and ALL documents

Business Owners Data Sheet

Business Income

Business Expenses

Auto Expenses

Home Office Expenses

Assets