List the first and last name of your tax preparer
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Are you a previous customer?
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Yes
No
Tax payer social security number
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First and last name
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DOB
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Spouse social security number (if none, type N/A)
Spouse first and last name (if none, type N/A)
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Spouse DOB (if none, type N/A)
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Address
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City
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State
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Zip Code
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Taxpayer occupation
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Home phone number
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Cell phone number
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Business phone number (if none, type N/A)
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Spouse occupation (if none, type N/A)
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Spouse cell phone number (if none, type N/A)
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Are you married?
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Yes
No
Filing status
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Single
Married filing joint
Married filing separate
Head of household (must fill out head of household sheet)
Widowed
Please list dependent #1 information
Please list dependent #2 information
Please list dependent #3 information
Please list dependent #4 information
Please list dependent #5 information
NOTICE
United Tax Solution will prepare your individual Federal Income Tax Return from the information you provide us. We will not audit or verify the information you furnished us to prepare your return. You, the Taxpayer, are ultimately responsible for the preparation of your Tax Return. I, the Taxpayer, have provided to United Tax Solution the attached accompanying tax information and to the best of my knowledge this information is true, correct, and complete.
TAXPAYER SIGNATURE
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SPOUSE SIGNATURE (if none, type N/A)
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DIRECT DEPOSIT ACCOUNT INFORMATION
Bank Name
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Routing Number
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Account Number
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Driver's License/State ID Number
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Issue Date
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Expiration Date
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State Issued
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NOTICE
If any of the above information is INCORRECT it will delay processing of the tax return. Please make sure all information is accurate. I declare that I understand the above questions and have answered them truthfully and to the best of my ability.
TAXPAYER SIGNATURE
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Date
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Month
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Day
Year
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