Valentinez Tax Solutions

Taxpayer Information
How can we assist you today?

Free estimateI want to file
Marital Status*

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

First NameLast Name
Taxpayer Date of Birth*

MonthDayYear
Date
Taxpayer Social Security Number*
Taxpayer Phone Number*
Taxpayer Occupation*
Check all that apply:*

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 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
Check all that apply:

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 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.
Taxpayer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Phone Number
Taxpayer Email Address
example@example.com
Spouse Email Address
example@example.com

DEPENDENTS INFORMATION

	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	Social Security Number
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Do you have a "Special Needs" child?

YesNo
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)

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

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
Proof of income*

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Upload your form of identification *

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

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How would you like to receive your tax refund (if any) deposited ?*

CheckingPrepaid card (offered by tax bank)Printed Check
Bank Name
Your Account Number
Bank Routing Number
Would you like to apply for an advancement loan

YesNo
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)
Do you use any part of your home regularly and exclusively for business?

YesNo
Estimated percentage of time spent in home office compared to total time spent in this business
Estimated of time in home office compared to total time in this business
Description of work done in home office
Description of work done outside of work office
Total area of home
Total area of home used regularly for business
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:
Data Release Consent

CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION
According to federal law, we are required to provide you with this consent form. Unless otherwise authorized by law, we cannot share your tax return information with third parties for any purpose other than preparing and filing your tax return without your consent. If you agree to the disclosure of your tax return information, please be aware that federal law may not provide protections against further use or distribution of that information. Signing this form is not mandatory; however, if you choose not to sign, it may impact the services we are able to provide to you. If you agree to the disclosure, you can specify how long your consent remains valid. If no duration is specified, your consent will be valid for one year.

You have expressed interest in obtaining a bank account, refund settlement product, card service, or other related banking services. These services are offered through our arrangements with financial institutions and their affiliates. In order to apply for and receive these products or services, we may need to share your information with these institutions and/or their affiliates.

By signing this form, you authorize Valentinez Tax Solutions to disclose your 2024 tax return and any information gathered during the preparation of your taxes to facilitate the issuance, processing, underwriting, and servicing of any refund settlement products and related banking services you apply for or obtain. These activities may be performed by the companies and/or their affiliates listed below.
Name*

First NameLast Name
Signature*

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Date*

MonthDayYear
Date
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Taxpayer Information

HEALTH INSURANCE COVERAGE:

Data Release Consent