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Please Select
Brittney Sanders Senior Tax Preparer
Leanedra Willis
Meagan Harris
Tequisha Witherspoon
Talisa Guy
Taxpayer's Name
Mr.
Mrs.
Prefix
First Name
Middle Name
Last Name
Suffix
Referral Person Name
Mr.
Mrs.
Prefix
First Name
Middle Name
Last Name
Suffix
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Age
Date of Birth
-
Month
-
Day
Year
Date
Taxpayer Social Security Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Did you file taxes last year?
Yes
No
Refund never received or taken
Awaiting an amendment results
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Social Security #
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
What year are you filing?
2025
2024
2023
2022
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Did you receive a federal tax last year?
Yes
No
Expenses
Please fill-up the information within the current year only.
General Expenses
Rows
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Expenses
Additional comments
Who referred you? How did you hear about us?
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Lush Life Tax & Consulting to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Lush Life Tax & Consulting
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Social Security and D/L
*
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Direct Deposit Form/ Account# and Routing #
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Include Bank Name in picture
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Bank Name
1095-A Health Care Market Place
College 1098-T Form
Dependents Social Security Card
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W2s
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Dependent Birth Certificates
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Do You Need Credit Repair? Choose a vacation or credit repair.
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I would like a vacation instead!
Would You Like A Free Vacation? Taxes & Fees Will Be Paid By Taxpayer! Choose a vacation or credit repair!
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