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WELCOME BACK! USE THIS FORM ONLY IF YOU FILED WITH FTB TAX LAST TAX SEASON
Client Name:*

First NameMiddle NameLast Name
E-mail*
example@example.com
Cell Number:*
SOCIAL SECURITY NUMBER*
Current Home Address:*

Street Address

Street Address Line 2

CityApartment #

Postal / Zip CodeCountry
WHAT COUNTY DID YOU LIVE IN LAST YEAR? *
Upload your W2's and 1099's

Please upload all of your new documents for this tax season...for example, your new W2's and 1099's
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DID YOU HAVE HEALTHCARE THROUGH MARKETPLACE? (OBAMACARE) if so, please upload your 1095A document below*

YESNO
Upload your 1095A Here

This is for anyone received HealthCare through Marketplace
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Please enter ANY NEW Dependent's Name, DOB & Relationship to You. (Upload their birth certificate, and social below)
IF YOU LIVED IN ANY OF THESE STATES...WHAT WAS THE SCHOOL DISTRICT IN YOUR AREA? (New York, New Jersey, Pennsylvania, Ohio, Illinois)
Upload New Dependents documents (Social, Birth Certificate and proof that the new dependent lives with you, for example, Doctor, school or health records.

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Have You Had a New Life Changing Event for example...Marriage, Divorce or Separation? If so, tell me about it.
DIRECT DEPOSIT INFORMATION
BANK NAME
TYPE OF ACCOUNT

CHECKINGSAVINGS
ACCOUNT NUMBER
ROUTING NUMBER
VERY IMPORTANT (Upload a selfie with you holding your ID beside your face) The IRS wants us to verify that it is you.*

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Should be Empty:

DIRECT DEPOSIT INFORMATION