Tax Amendment
Hello, and thank you for considering Flourish Financial Group for all your financial needs! Please fill out this form and upload your documents to begin the filing process. I will reach out to you with your documents for review and signature before submitting your return to the IRS. Rooted in Growth, Built for Prosperity.
Amendment Reason:
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Identity Theft/ Fraud
Filed Income Incorrectly
I Never Received My Taxes
IRS Asked Me To Amend
I Forgot To File 1095A Form
What years did you successfully receive a tax return?
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2025
2024
2023
2022
2021
2020
Did you file 2024 taxes?
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Yes
No
Did you successfully receive your 2024 taxes?
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Yes
No
Please explain the reason you believe an amendment is required.
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I need as much detail about your situation as possible in order to provide an assessment. Please be honest because I need to know what your amendment will require.
IRS NOTICE:
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Any Documents Or Letters From IRS
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ORIGINAL RETURN:
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Include The Return That Needs To Be Amended Here
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OTHER RELEVANT DOCUMENTS:
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You May Include Any Other Important Documents
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Taxpayer's Full Name:
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Social Security Number:
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Date of Birth:
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Month
-
Day
Year
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Occupation:
Email
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example@example.com
Phone Number:
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Spouse Name: (This info is required even you file separately)
Spouse Social Security Number:
Spouse Date of Birth:
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Month
-
Day
Year
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Current Address: (Please include Street Address, Unit Number, City, State, Zip Code)
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Is this the same address filed on last year's return? If not, it is okay! This is for verification purposes ONLY!
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Yes
No
Previous Address: (Only if you have moved since last year's return)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Filing Status:
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Single
Married Filing Jointly
Married Filing Separately
Head of Household (Must have dependents)
Qualifying Widow
Dependent #1 Full Name:
Dependent Social Security Number:
Dependent Date of Birth:
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Month
-
Day
Year
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Relationship to Dependent:
Dependent #2 Full Name:
Dependent Social Security Number:
Dependent Date of Birth:
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Month
-
Day
Year
Date Picker Icon
Relationship to Dependent:
Dependent #3 Full Name:
Dependent Social Security Number:
Dependent Date of Birth:
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Month
-
Day
Year
Date Picker Icon
Relationship to Dependent:
Dependent #4 Full Name:
Dependent Social Security Number:
Dependent Date of Birth:
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Month
-
Day
Year
Date Picker Icon
Relationship to Dependent:
Did you pay someone to watch your child(ren)?
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Yes
No
I don't have children
Do you or any other persons on this return receive an IP PIN from the IRS?
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Yes
No
If yes, list all names and corresponding IP PIN numbers below.
Did you collect social security or retirement income?
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Yes
No
Did you purchase health insurance through healthcare.gov marketplace (Obama Care) and receive a 1095-A form?
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Yes
No
If yes, did you receive a 1095-A Form from the Marketplace?
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Yes
No
This does not apply to me
Were you ever disallowed the E.I.T.C prior to this year?
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Yes
No
Did you make college tuition payment and received a 1098-T Form?
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Yes
No
Do you have any other income other than W2(s)?
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Yes
No
If so, what kind of income?
Are you delinquent in any of the following?
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Child Support
Alimony
Student Loans
Back Taxes
State Taxes
None of The Above
How would you like to receive your refund?
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Refund Transfer Direct Deposit (Fastest Method)
Refund Transfer Paper Check
Bank Name:
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Bank Routing Number: PLEASE VERIFY
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Bank Account Number: PLEASE VERIFY
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Valid Photo Identification:
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Primary Taxpayer AND Spouse If Married
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Taxpayer Social Security Card:
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Primary AND Spouse If Married
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Dependent(s) Social Security Card(s)
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Please Upload ALL Dependent Information Here
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All Income Documents
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W2, 1099, Social Security, Investments, etc.
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I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Flourish Financial Group LLC to prepare my taxes based on the information I provided. I understand that I am financially responsible for any balance owed.
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Yes
Signature
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Flourish Financial Group also provides credit repair and business funding services. Would you be interested in booking a free consultation to turn your financial goals into your reality?
*
Yes, I would!
No, I’m not interested in securing financial freedom.
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