Please fill out this form and once it’s completed, we will confirm an appointment with your tax preparer and they will be in contact with you.
CLIENT INFORMATION SHEET
WERE YOU REFERRED BY SOMEONE
HAVE YOU BEEN AUDITED IN THE LAST 3 YEARS?
*
Please Select
Yes
No
Tax Preparer Request
*
Please Select
Jessica (Jess)
Marleah (Leah)
Sharnetta (Netta)
Dizhene (Nae)
Cadris
Jasmine (Jas)
Zarolyn (Zay)
Anybody
Appointment request
Time
Minutes
AM
PM
AM/PM Option
Date
/
Month
/
Day
Year
TAXPAYER NAME:
Last
*
MI
*
First
*
TAXPAYER SOCIAL
*
Ip pin
Identity pin from the irs
TAXPAYER DATE OF BIRTH
*
/
Month
/
Day
Year
TAXPAYER PHONE NUMBER
*
TAXPAYER EMAIL
*
TAXPAYER ADDRESS:
City
*
State
*
Zip Code
*
(Drivers license, id, or green card)
*
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of
Social security card
*
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SPOUSE NAME:
Last
MI
First
SPOUSE SOCIAL
SPOUSE DATE OF BIRTH
/
Month
/
Day
Year
SPOUSE PHONE NUMBER
Drivers license, id or green card
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of
Social security card
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of
Dependent NAME:
Last
MI
First
Dependent (1) SOCIAL
Dependent (1) DATE OF BIRTH
/
Month
/
Day
Year
Date
Social security card
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Last
MI
First
Dependent (2) SOCIAL
Dependent (2) DATE OF BIRTH
/
Month
/
Day
Year
Social security card
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of
Last
MI
First
Dependent (3) SOCIAL
Dependent (3) DATE OF BIRTH
/
Month
/
Day
Year
Social security card
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of
Last
MI
First
Dependent (4) SOCIAL
Dependent (4) DATE OF BIRTH
/
Month
/
Day
Year
Social security card
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DUE DILIGENCE CHECKLIST
EMPLOYMENT STATUS:
*
Please Select
Employed
Self-Employed
Not-Employed
W2 or any tax forms
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Was your main home in the u.s for more than half of the year?
*
Please Select
Yes
No
ARE YOU IN THE PROCESS OF BUYING OR PURCHASING A HOME?
*
Please Select
Yes
No
1095 mortgage statement form
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DID YOU, YOUR SPOUSE OR DEPENDENT(S) RECEIVE HEALTH INSURANCE THROUGH THE MARKETPLACE AND RECEIVE FORM 1095-A?
*
Please Select
Yes
No
DID YOU, YOUR SPOUSE OR DEPENDENT(S) ATTEND COLLEGE THIS YEAR? DID YOU, YOUR SPOUSE AND/OR DEPENDENT(S) RECEIVE UNEMPLOYMENT?
*
Please Select
Yes
No
1098-t school form
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DO YOU HAVE ANY DEBTS WITH THE IRS, US TREASURE, CHILD SUPPORT, STUDENT LOANS, FEMA OR ANY GOV'T ENTITY?
*
Please Select
Yes
No
DID YOU MAKE ANY CHARITABLE CONTRIBUTIONS?
*
Please Select
Yes
No
DID YOU HAVE ANY INCOME FROM SELF-EMPLOYMENT, RENTAL PROPERTIES, INVESTMENTS, OR OTHER SOURCES?
*
Please Select
Yes
No
IF YOU WERE SELF-EMPLOYED, DO YOU HAVE EXPENSES TO SHOW PROOF OF THE INCOME CLAIMED?
*
Please Select
Yes
No
ARE YOU CONTRIBUTING TO 401K OR ANY OTHER PRE TAX ACCOUNTS?
*
Please Select
Yes
No
COULD ANOTHER TAXPAYER QUALIFY TO CLAIM THIS DEPENDENT IF SO WHO
*
IS THE DEPENDENT(S) YOU ARE CLAIMING A CITZEN, NATIONAL OR RESIDENT OF THE UNITEd STATES?
*
Please Select
Yes
No
DID THE DEPENDENT RESIDE WITH YOU FOR THE FULL YEAR?
*
Please Select
Yes
No
THE DEPENDENT YOU ARE CLAIMING IS (1) unmarried OR (2) married AND CAN BE CLAIMED AS A DEPENDENT AND NOT FILING MARRIED FILING JOINTLY?
*
Please Select
Yes
No
DID YOU RECEIVE ANY TYPE OF GOVERNMENT ASSISTANCE?
*
Please Select
Food stamps
Housing
No
DO YOU CERTIFY THAT ALL THE INFORMATION PROVIDED ON THIS FORM, TO THE BEST OF YOUR KNOWLEDGE IS TRUE?
*
Please Select
Yes
No
Taxpayer Signature
*
Spouse Signature
Submit
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