Tax Return Questionnaire

Taxpayer Information
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er) with Dependent Children
Taxpayer Name

First NameLast Name
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer Occupation
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Email Address
example@example.com
Taxpayer SSN:
Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Occupation
Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Phone Number
Format: (000) 000-0000.
Email
example@example.com
Spouse Email Address
example@example.com

DEPENDENTS INFORMATION

Rows	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	SSN
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

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)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) 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?
File Upload

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CheckingSavings
Bank Name
Your Account Number
Bank Routing Number
Would you like you apply for the Cash Advance?
Business Income & Expenses (Sole Proprietorship, LLC)
Owner Name

First NameLast Name
Business name
Employer ID number
Business Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer ID number (EIN)
YesNo
Please upload any additional tax documents below:

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Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:
Should be Empty:

Taxpayer Information