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Taxpayer Information
DID YOU FILE WITH LUXE CAPITAL LAST YEAR?
Please Select
Yes
No
TAX YEAR YOU ARE FILING
ARE YOU IN DEBT WITH IRS
YES
NO
DON'T KNOW
DID YOU RECEIVE AN IRS PIN?
Please Select
Yes
No
IF YOU HAVE AN IRS PIN# PLEASE ENTER HERE
FILING STATUS
Please Select
SINGLE
MARRIED FILING SEPARATELY
MARRIED FILING JOINTLY
HEAD OF HOUSEHOLD
TAXPAYER NAME
*
First Name
Middle Name
Last Name
Suffix
TAXPAYER ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TAXPAYER PHONE NUMBER
Please enter a valid phone number.
TAXPAYER EMAIL
example@example.com
TAXPAYER SOCIAL SECURITY
*
DATE OF BIRTH
-
Month
-
Day
Year
Date
TAXPAYER OCCUPATION
ARE YOU A US CITIZEN?
Please Select
YES
NO
ARE YOU A RESIDENT?
Please Select
YES
NO
NOT APPLICABLE
ARE YOU TOTALLY AND PERMANENTLY DISABLED?
Please Select
YES
NO
ARE YOU LEGALLY BLIND?
Please Select
YES
NO
ARE YOU A DEPENDANT OF ANYONE ELSE?
Please Select
YES
NO
SPOUSE INFORMATION
SPOUSE NAME
First Name
Middle Name
Last Name
Suffix
SPOUSE ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SPOUSE PHONE NUMBER
Please enter a valid phone number.
SPOUSE EMAIL
example@example.com
SPOUSE SOCIAL SECURITY NUMBER
DATE OF BIRTH
-
Month
-
Day
Year
Date
DATE OF DEATH
-
Month
-
Day
Year
Date
SPOUSE OCCUPATION
ARE YOU A US CITIZEN?
Please Select
YES
NO
ARE YOU A RESIDENT?
Please Select
YES
NO
NOT APPLICABLE
ARE YOU LEGALLY BLIND?
Please Select
YES
NO
ARE YOU A DEPENDENT OF ANYONE ELSE?
Please Select
YES
NO
DEPENDENT
DEPENDENT #1 NAME
First Name
Middle Name
Last Name
Suffix
SOCIAL SECURITY NUMBER
DATE OF BIRTH
-
Month
-
Day
Year
Date
RELATIONSHIP
Please Select
SON
DAUGHTER
PARENT
OTHER
IS CHILD TOTALLY AND PERMANENTLY DISABLED?
Please Select
YES
NO
HOW MANY MONTHS DID THEY LIVE WITH YOU?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
DEPENDENT #2 NAME
First Name
Middle Name
Last Name
Suffix
SOCIAL SECURITY NUMBER
DATE OF BIRTH
-
Month
-
Day
Year
Date
RELATIONSHIP
Please Select
SON
DAUGHTER
PARENT
OTHER
IS CHILD TOTALLY AND PERMANENTLY DISABLED?
Please Select
YES
NO
HOW MANY MONTHS DID THEY LIVE WITH YOU?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
DEPENDENT #3 NAME
First Name
Middle Name
Last Name
Suffix
SOCIAL SECURITY NUMBER
DATE OF BIRTH
-
Month
-
Day
Year
Date
RELATIONSHIP
Please Select
SON
DAUGHTER
PARENT
OTHER
IS CHILD TOTALLY AND PERMANENTLY DISABLED?
Please Select
YES
NO
HOW MANY MONTHS DID THEY LIVE WITH YOU?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
DEPENDENT #4 NAME
First Name
Middle Name
Last Name
Suffix
SOCIAL SECURITY NUMBER
DATE OF BIRTH
-
Month
-
Day
Year
Date
RELATIONSHIP
Please Select
SON
DAUGHTER
PARENT
OTHER
IS CHILD TOTALLY AND PERMANENTLY DISABLED?
Please Select
YES
NO
HOW MANY MONTHS DID THEY LIVE WITH YOU?
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
TAX RELATED QUESTIONS
DOES ANY DEPENDENT HAVE TUITION EXPENSES?
Please Select
CHILD 1
CHILD 2
CHILD 3
CHILD 4
DOES ANY DEPENDENT HAVE CHILD CARE?
Please Select
CHILD 1
CHILD 2
CHILD 3
CHILD 4
DO YOU OWN YOUR HOME
Please Select
YES
NO
DO YOU HAVE ANY PAPERWORK SHOWING PROPERTY TAXES?
Please Select
YES
NO
ANY OTHER INFO YOU NEED US TO KNOW
INCOME
SELECT ALL FORMS OF INCOME
WAGES OR SALARY (W2 FORM)
UNEMPLOYMENT
PENSION/RETIREMENT
RENTAL INCOME
FARM INCOME
DIVIDEND/SALE OF STOCK
INTEREST INCOME
SELF EMPLOYMENT/BUS INCOME (SCH C)
ALIMONY RECEIVED
LOTTERY OR GAMBLING
PUBLIC/STATE AID
SOCIAL SECURITY INCOME
TIPS
OTHER
PLEASE SELECT ALL GENERAL EXPENSES
IRA
PROPERTY TAX
MORTGAGE/CLOSING POINTS
BUSINESS OWNER/SELF EMPLOYED
TAX PREP EXPENSES
UNION DUES
EDUCATIONAL EXPENSES
SIGNIFICANT LOSS OR THEFT
CHARITY OF RELIGIOUS CONTRIBUTIONS
MORTGAGE INVESTMENT
MOVING EXPENSES
MEDICAL EXPENSES
ALIMONY PAID
BOUGHT OR SOLD HOME
OTHER
UPLOAD ALL DOCUMENTS .................................................. PLEASE INCLUDE COPY OF DRIVERS LIC FOR ALL TAXPAYERS
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