Essence Trust Financial Client Data Sheet

Client Data Sheet
Full Name*

First NameLast Name
Social Security number*
D.O.B*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
E-mail
example@example.com
PHONE CARRIER (Ex: Verizon, t-mobile, metro-pcs, etc)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SingleHead of HouseholdMarried filling jointlyMarried filling separatelyWidower
If Married filling jointly or separately (Spouse information, DOB, SSN, PHONE #, EMAIL)
Did you have any Insurance through the Marketplace (Obamacare, Oscar, Florida Blue, etc. form 1095-A)
Dependent D.O.B & SSN, if any.
Upload All Document: (Ex: driver license, social, kids birth certificate, w2, 1099-nec, 1098-t, etc)

Cancelof
DUE DILIGENCE CHECKLIST (HOH, MFJ, MFS, S)

This is to make sure the right credit is applied on your tax to avoid refund delay
Were you Married or have you ever been married?
Is there a possibility the child can be claim by another taxpayer? (Such as father of the QC)
Do you provide more than half of support to the qualifying child?
Does the child live with you for more than half the year?
Can you provide proof that you support QC? (such as, utility bills, daycare expense, medical bills, leasing agreement etc)
If divorced or legally separated, can you provide proof that you reside in different addresses for more than half the year?
Did you receive any additional support financially throughout the year of 2025? (such as, child support, student loans, unemployment)
If filing with a QC that is not yours, did the custodial give consent to file with the QC? if so, can you provide proof?
Signature*
Should be Empty:

Client Data Sheet

DUE DILIGENCE CHECKLIST (HOH, MFJ, MFS, S)