Tax Information Form

Tax Information Form

Please fill out this form to provide your tax information.
Personal Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Occupation
Social Security Number
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a US citizen?

YesNo
Income (Check all that apply and attach copies)

W2W2G1099R1099DIV1099 INT1099G1099MISC1099NEC1099SSA
Spouse Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Social Security Number
Occupation
Income (Check all that apply and attach copies)

W2W2G1099R1099DIV1099 INT1099G1099MISC1099NEC1099SSA
Dependents Information

If your dependents have received any tax forms (W2, 1099, 1098, etc), please attach those at the end of this form.
Dependents
Itemized Deduction

If Applicable (Only Needed if Deductions are More than $25,000)
Home Property Tax
Vehicle Property Tax 1
Vehicle Property Tax 2
Mortgage Interest Amount
Charitable Mileage
Charitable Contributions
Any Losses (Causulity Loss)
Tax Prep Fees
Tax Filing Status

SingleMarried filing jointlyMarried filing separatelyHead of householdQualifying widow(er) with dependent child
Additional Information
Business Name 1 or Source of Non-W2 Income
Please complete the following for each business. This would include Lyft, Uber, Door Dash, 1099 Income, etc)
Business Name 2 or Source of Non-W2 Income
Please complete the following for each business. This would include Lyft, Uber, Door Dash, 1099 Income, etc)
Tax Type Paid
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Tax Type Paid
State of Tax Payment
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Date Paid

MonthDayYear
Date
Tax Paid
Please attached or upload prior year tax return and all tax forms received to include W2, 1099, 1098, IRS or state correspondence, drivers license for taxpayer and spouse)

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Disclaimer: Thank you for your interest in being a client of BSC Consultants, LLC. This form is used to collect information about new clients and is for internal purposes only. The information you provide is confidential and will be treated accordingly. By signing and submitting this form, you are hereby authorizing BSC Consultants, LLC to prepare and complete tax return(s) based on the data provided.
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Tax Information Form

Personal Information

Spouse Information

Dependents Information

Itemized Deduction