ZOOM TAXPAYER QUESTIONNAIRE

REFUND ESTIMATE / ESTIMADO DE REEMBOLSO
Name / Nombre*

First NameMiddle NameLast Name
Email*
example@example.com
Address / Direccion

Address

Address line 2

City/TownState/Region/Province

Zip/Post Code
Phone Number / Numero de Telefono*
Please enter a valid phone number.
DOB / Fecha de Nacimiento*

MonthDayYear
Do you have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Filing status / Estado Civil*

Single / SolteroHead of Household / Cabeza de HogarMarried filing Jointly / Casado declarando conjuntamenteMarried Filing Separately / Casado Declarado por SeparadoWidow / Viuda(o)
Spouse's Name / Nombre del conyuge*

First NameLast Name
Spouse's DOB / Fecha de Nacimiento del conyuge*

MonthDayYear
Date
Does your spouse have a social security card or an ITIN? / Su conyuge tiene seguro o ITIN?*

Social security card / seguro socialITIN
If single or head of household: are you married? / Si es soltero o cabeza de Hogar, esta usted casado?*

Yes / SiNo
If you are the head of the household, have you paid over half of the expenses for maintaining the home? / Si es Cabeza de Hogar, Pago usted mas de la mitad de la manutencion de la casa?*

Yes / SiNo
What bills do you have under your name? Que biles tiene a su nombre?*

Electricity bill / LuzWater bill / AguaGas bill / GasInternet bill / InternetTelephone bill / telefonoBank statement / estados de cuentaRent Lease - contrato de la rentaOther
Do you have dependents? Tienes dependientes?*

Yes / SiNo
How many? Cuantos?*

123456
Dependent #1 age/ Edad de Dependiente #1*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
Dependent #2 age/ Edad de Dependiente #2*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
Dependent #3 age/ Edad de Dependiente #3*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
Dependent #4 age/ Edad de Dependiente #4*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
Dependent #5 age/ Edad de Dependiente #5*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
Dependent #6 age/ Edad de Dependiente #6*
Does your dependent have a social security card or an ITIN? / Usted tiene seguro o ITIN?*

Social security card / seguro socialITIN
Relationship / Relacion*

daughter / hijason / hijobrother / hermanosister / hermananephew / sobrinoniece / sobrinamother / madrefather / padregrandparent/abuelo (a)stepchild / hijastro(a)Foster child / nino acogidoOther / Otro
AGE TEST.- Is your child 19+ and under 24? /Su dependiente es 19+ y menor de 24?*

Yes /SiNo
Is your dependent 19 or over and permanently and totally disabled? Su dependiente tiene 19 o mas y esta completamente discapacitado?*

Yes /SiNo
Is your dependent 19 or over and a full-time student? Su dependiente tiene 19 o mas y estudiante a tiempo completo?*

Yes /SiNo
Upload your form 1098-T / Sube tu forma 1098-T*

Cancelof
What is your source of Income? Cual es su fuente de ingreso?*

Employment - EmpleoSelf-employment - Empleo PropioWelfareChild Support - ManutencionFood Stamps - Estampillas Child SupportUnemployment - Desempleo -Social Security - Seguro SocialRental Property - RentasGambling - Juegos de AzarRetirement - Fondos de RetiroInvestments - InversionesAlimony - Pension AlimenticiaPension - pensionPrizes - PremiosScholarships - BecasJury-Duty Pay - Pago de JuradoOther
What is your gross (with no expenses)income? / Cual es su ingreso total? (sin gastos)*
What is the total of your expenses? Cual es el total de sus gastos?*
Upload all the your forms you received/ Sube todas las formas que has recibido*

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Do you have health insurace? / Tiene seguro Medico?*

Yes /SiNo
Which one? Cual?*

Private -PrivadoThrough Employer-Mediante EmpleadorMedicalCovered California-Obamacare
Are you a Full-Time Student? Es usted Estudiante a Tiempo Completo?*

Yes /SiNo
What proof do you have? Que prueba tiene?*

1098-TTranscripts -TranscripcionesSchool Letter - Carta de EscuelaReceipts - Recibos
Upload your form 1098-T / Sube tu forma 1098-T

Cancelof
Terms and Conditions *

I declare under penalty of perjury under laws of Internal Revenue Services and State of California that the foregoing is true and correct. / Declaro bajo pena de perjurio bajo las leyes de Internal Revenue Services y State of California que lo anterior es cierto y correcto.
Date - Fecha*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Signature*

Clear
Should be Empty:

REFUND ESTIMATE / ESTIMADO DE REEMBOLSO