Client Tax Form

Tax Information Request Form

CyberTax Services LLC
Taxpayer Information

2025 Tax Year
Filling Status
Taxpayer Full Name

First NameLast Name
SSN
DOB
Date of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do I have permission to text you?

YESNO
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Cellphone Carrier
Sprint, T-Mobile, Metro, AT&T, Verizon ... etc.
Email Address
example@example.com
Spouse Information

if filling, Married filling Jointly
Spouse Full Name

First NameLast Name
DOB
Date of Birth
SSN
Social Security Number
Email Address
example@example.com
Do I have permission to text you?

YESNO
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Cellphone Carrier
Sprint, T-Mobile, Metro, AT&T, Verizon ... etc.
Dependent Information

Rows	Dependent Name	DOB (Date of Birth)	Relationship	SSN
1
2
3
4

Did you provide more than 50% support to the dependents listed above?

YESNO
Can anyone claim any of the dependents above on their tax return?

YESNO
Did the dependent lived with the taxpayer for at least 12 months?

YESNO
Are there any child/dependent care expenses you will like to report?

YESNO
If Yes, Please Provide Caregiver Name, Address, EIN/SSN in the fields below
Day Care / Caregiver Name
NAME
SSN or EIN
Address
Example: 123 Main St New Orleans, LA 70119
Identify/ Protection
Are you a Victim of Identify Theft?

YESNO
Was you assist any IIP pin from the IRS?
"Please Type PIN "
Are you interested in audit protection for 2025? (optional) if so... $60 extra charge may apply

YESNO
Health Insurance

2025 Tax Year
Did you have health Insurance coverage for the whole year of 2025?

YESNO
Did you received any " Marketplace Insurance in 2025 " ? (Form 1095-A, B, C)

YESNO
Advance Loan Option
Do you want to apply for an Advance Refund Loan? ($35 Fee may apply)

YESNO
Refund Advance Loan options, including Loans of $250, $500, and $1,000 at 0% interest, and high-amount loans up to $7,500 with a 36% APR.
Income Sources (Check all that apply)
W-2 (Employment)1099-NEC / 1099-MISCSelf-Employment / Business Income/ Gig Work (Uber, DoorDash, Amazon, Spark, etc.)Rental IncomeInterest / Dividends (1099-INT / 1099-DIV)Unemployment (1099-G)/ Social Security (SSA-1099)Retirement / PensionOthers
Account Information

Direct Deposit
Bank Name
Routing Number
Account Number
CheckingSavingCheck
Documentation
REQUIRED Upload the following Document
- ID or Driver License (NOR EXPIRED)
- Last year Tax Return (if possible)
- Marketplace Insurance 2025 Form 1095 A B C
Income Documentation (Upload ALL that apply)
- W-2 (all employers)
- 1099-NEC, 1099-MISC, 1099-K
- Business income statements (Uber, Lyft, DoorDash, Instacart, Stripe, PayPal, Cash App, etc.)
- Bank statements showing business deposits (if no 1099 issued)
- Other income (W-2G, unemployment, side gigs, cash income)
Taxpayer Responsibility Notice

The taxpayer certifies that all income sources have been disclosed and that documentation provided is complete and accurate to the best of their knowledge. Additional documentation may be requested if required for compliance.
File Upload

Cancelof
“I certify that the above information is true and complete to the best of my knowledge and understand it will be used to determine my filing status and credits.”
Signature*
Should be Empty:

Tax Information Request Form

Taxpayer Information

Spouse Information

Dependent Information

Identify/ Protection

Health Insurance

Advance Loan Option

Income Sources (Check all that apply)

Account Information

Documentation