Verafied Taxes Submission Form

Verafied Taxes Submission Form

Please complete this form in its entirety. The more information I have about your tax situation, the faster I can get your refund on its way. Please submit all requested documents.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Date Of Birth
State ID or Driver's License #
Issue Date
Expiration Date
Do you have Marketplace Health Insurance?
If available, Please upload your 1095-A

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Filing Status
Are you filing:
Spouse Name: (For Married filing Joint or Separately)

First NameLast Name
Spouse Phone
Please enter a valid phone number.
Spouse Email
example@example.com
Spouse Social Security Number
Spouse Date of Birth
Spouse ID or Driver's License #
Issue Date
Expiration Date
Are you or your spouse permanently disabled?
Spouse Occupation

Self-Employed Income

Fill this out ONLY if you checked Self-Employed.
Business Name
Job Description
Months on Job
Self-Employment Income Amount
EIN Number
Check Here if you do not have an EIN Number.

No EIN

HouseHold Income Worksheet

Only fill out this section IF you were paid cash and worked inside the home
Job Title/Description
Name of Person you did work for
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount Made
This cannot exceed $2,400.
Do you have another Household income job?
If yes, we will contact you for this information.

Education
College Name
Total Amount Spent On School Supplies
Did you attend this school for more than half the year?

YesNo
Do you have a 1098T? If yes, please upload here

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Dependents
Name

First NameLast Name
Date Of Birth
Social Security Number
Relationship to You (the taxpayer)
Is this dependent disabled?
Did you provide more than 50% support?
Did this dependent live with you more than 50% of the year?
Can anyone else claim this dependent?
Have you received any advanced child tax credits?
If this dependent can be claimed by someone else, Please explain here
Do you have another dependent?

YesNo
Name

First NameLast Name
Date Of Birth
Social Security Number
Relationship to You (the taxpayer)
Is this dependent disabled?
Did you provide more than 50% support?
Did this dependent live with you more than 50% of the year?
Can anyone else claim this dependent?
Have you received any advanced child tax credits?
If this dependent can be claimed by someone else, Please explain here
Upload Documents for all dependents

Upload Social Security Cards, Birth Certificates, etc.
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Due Diligence
Are you married?

YesNo
What is the name of the non-custodial parent and why is he/she not claiming the dependent?
If you are separated or divorced, when is the last date you lived in the home?
Do you have joint custody? If yes, how many months did the dependent(s) live with the other parent?
Do you have a signed form 8332? (Custodial Parent Release of Claim of Dependent(s) on tax return)

YesNo
Did anyone else live in the home that provides financial support for your dependent(s)? If so, how much do they pay? If not, just answer "no".
Are your dependent(s) biologically yours?
Do you or anyone else receive financial aid for dependent(s)?
Are you applying for a loan advance?
Refund Receive Type
How would like to receive your refund?
Bank Name
Account Number
Routing Number

Document Uploader

Use this section to upload ID Cards, W-2s, Social Security Cards, Birth Certificates, Pay Stubs, SNAP/TANF Award Letter, Unemployment 1099-G, etc.
File Upload (You can upload multiple files)

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Name of the person who referred you
How did you hear about Verafied Taxes?

Regarding Qualifying Children for Earned Income Credit

According to the information you provided in regards to the dependent(s), the dependent(s) is/are your biological child, grandchild, niece, or nephew, etc.

I discussed with you a qualifying child cannot be used by more than one person per tax period. One person is one of the parent(s) if married filing jointly.

If filing Head of Household, you attest that you can provide a lease or utility bill in your name at your current address.

Please note: You are stating that you provide over 50% of care and support for the dependent(s), you are the sole provider for the dependent(s), the dependent(s) lives with you for more than half the year, and no one else is eligible to claim the dependent(s).

By signing below, you are stating that the dependent(s) information on your tax return is true, correct, and has been documented by your preparer. You are stating that you are not providing your preparer with any false/fraudulent information.
ANY AND ALL INFORMATION HAS BEEN FILLED OUT BY ME TO THE BEST OF MY KNOWLEDGE. THE DATA FILLED OUT BY ME, (THE TAXPAYER) ,IS ACCURATE AND TRUTHFUL. I give, Schilacy's Tax Service., authority to use the information provided by myself, the taxpayer, for filing purposes.

I am providing my electronic signature by typing my full name in the box below. I know that I will receiving an email where I will be asked for my official signature on the final paperwork.
Type Your Full Name Below:
Should be Empty: