Tax Return Questionnaire

Name of person who referred you(if any)
Taxpayer Information Form
Taxpayer Information
Marital Status
Taxpayer Name

First NameMiddle NameLast Name
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer Occupation
Check all that apply:
Spouse Name

PrefixFirst NameMiddle NameLast NameSuffix
Spouse Date of Birth

MonthDayYear
Date
Spouse Occupation
Check all that apply:
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number
Format: (000) 000-0000.
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Phone Number
Format: (000) 000-0000.
Taxpayer Email Address
example@example.com
Spouse Email Address
example@example.com
Upload ID/DL front and back taxpayer and spouse

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DEPENDENTS INFORMATION

Rows	FULL DEPENDENT NAME	DOB	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	Check if College Student
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Do you have a "Special Needs" child?
CHILD TAX CREDIT PAYMENT AMOUNT
HEALTH INSURANCE COVERAGE:
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A
Please upload 1095A

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Wages and Salaries (Attach W-2's)

Self Employment income

1099 income statementd

Unemployment Compensation Received (FORM 1099G)

IRA and HSA Contributions

Educator Expenses

PLEASE UPLOAD FORM BELOW:
File Upload

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Were you, your spouse, or any dependent registered in college? Do you have a form 1098T?
1098 T File Upload

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Did you have any college related expenses
Do you or your spouse have a small business or other income?
If yes, fill out next section

If No skip to refund section

Business Income & Expenses (Sole Proprietorship, LLC) If Applicable
Business name
Business Type
Employer ID number (EIN)
Owner Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload business income

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Do you use any part of your home regularly and exclusively for business?
Total area of home
Total area of home used regularly for business
Do you a vehicle regularly for business?
Year make and model of vehicle
When did you first begin using this vehicle for business?
Total miles driven all year
Total business miles driven all year
Please upload any additional business expenses below:

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Would you like your refund(if any) sent via check, prepaid card, or bank deposit?
Would you like to apply for a Refund Anticipation Loan?
If you would like your tax refund (if any) deposited directly into your bank
Bank Name
Bank Routing Number
Your Account Number
Employer ID number
Estimated of time in home office compared to total time in this business
Description of work done in home office
If yes, what percentage did you occupy as a tenant?
Check all that apply

Other
Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:
I confirmed that all information I entered here is accurate and true. I allow CRYSTAL CLEAR TAX to capture my sensitive data like personal id, government id, and other information. I have read the terms and conditions and privacy policy of CRYSTAL CLEAR TAX. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
I confirmed that all information I entered here is accurate and true. I allow Crystal Clear Tax to capture my sensitive data like personal id, government id, and other information. I have read the terms and conditions and privacy policy of Crystal Clear Tax. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return. Signature verifying information submitted is correct to the best of your knowledge
Should be Empty:

Taxpayer Information Form

Taxpayer Information

HEALTH INSURANCE COVERAGE: