TAX PAYER APPLICATION

TAX PAYER APPLICATION
Thank you for allowing us to prepare your tax return. It is very important for you to complete the application below to help our tax preparer complete an accurate tax return. If you have any questions, please ask. Please review and complete the entire form and also provide us with the additional items we need below to complete your tax return. Please also upload documents at the end of this application.
- Tax information such as W-2s, 1099s, 1098s.
- Social security cards or a letter from the SSA for you and all persons on your tax return.
- Proof of Identity (such as Driver's license or State ID).
Part I. Your Personal Information
1. Your First Name*

First NameMiddle InitialLast Name
2. Spouse's First Name

First NameMiddle InitialLast Name
3. Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. E-mail*
example@example.com
Home Phone
Format: (000) 000-0000.
Cell Phone*
Format: (000) 000-0000.
Cell Phone Carrier
5. Your Date of Birth*

MonthDayYear
Date
9. Your Social*
6. Your Occupation*
YesNo
8. Spouse's Date of Birth

MonthDayYear
Date
9. Spouse's Social
9. Spouse's Occupation
YesNo
YesNo
Part II. Family and Dependent Information
SingleMarried
YesNo
YesNo

2. List the names of everyone below who lived in your home that you supported during the past 12 Months

Rows	Enter your dependents First and Last Name Do not enter your name or Spouse's name below.	Date of Birth (M/D/Y)	Social Security Number	Number of months lived in your home	Relationship to you (i.e. son, daughter, mother, sister)
1
2
3
4
5
6

Do you pay for childcare expenses?
Name of Daycare/Individual:
Address for child care expenses

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
EIN of Daycare or Social of Individual
Earned Income Credit Due Diligence Questions
YesNo
YesNo
YesNo
YesNo
YesNo
Do acknowledge the tiebreaker rules when it comes to claiming a dependent child. TIEBREAKER RULES: To determine which person can treat the child as a qualifying child, the following tiebreaker rules apply: If only one of the persons is the child’s parent, the child is treated as the qualifying child of the parent. If the parents do not file a joint return together but both parents claim the child as a qualifying child, the IRS will treat the child as the qualifying child of the parent with whom the child lived for the longer period of time during the year. If the child lived with each parent for the same amount of time, the IRS will treat the child as the qualifying child of the parent who had the higher adjusted gross income (AGI) for the year. If no parent can claim the child as a qualifying child, the child is treated as the qualifying child of the person who had the highest AGI for the year. If a parent can claim the child as a qualifying child but no parent does claim the child, the child is treated as the qualifying child of the person who had the highest AGI for the year, but only if that person’s AGI is higher than the highest AGI of any of the child’s parents who can claim the child.

YesNo

Consent to Use of Tax Return Information
Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.
You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.
If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.
For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for a Refund Anticipation Loan (RAL), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.
If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your retum, please sign and date this consent to the use of your tax return information.
By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2025 tax return to determine whether to present you with the opportunity to apply for these products and services and you attest under penalty of perjury that the above information is true.
Printed name of Taxpayer:
Printed Name of Joint Taxpayer:
Taxpayer Signature:

Clear
Joint taxpayer Signature:

Clear
Date:

MonthDayYear
Date
Date:

MonthDayYear
Date
3
Should be Empty:

TAX PAYER APPLICATION

Part I. Your Personal Information

Part II. Family and Dependent Information

Earned Income Credit Due Diligence Questions

Part III. Income and Expenses. In 2025 did you (or your spouse) receive or pay:

Part VI. Schooling - In 2025 Did you (or your spouse):

Part V. Referral - Please check one of the following below:

Consent to Use of Tax Return Information