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  • Tax Payer Information form

    Qualifier Form

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    • Dependent #1 

    • Dependent Name:         
      Date of Birth:   Pick a Date   
      Social Security:      
      Relationship:      
      Months in Your Home:      
      Full or Shared Custody:         

    • Dependent #2 

    • Dependent Name:         
      Date of Birth:   Pick a Date   
      Social Security:      
      Relationship:      
      Months in Your Home:      
      Full or Shared Custody:         

    • Dependent #3 

    • Dependent Name:         
      Date of Birth:   Pick a Date   
      Social Security:      
      Relationship:      
      Months in Your Home:      
      Full or Shared Custody:         

    • Dependent #4 

    • Dependent Name:         
      Date of Birth:   Pick a Date   
      Social Security:      
      Relationship:      
      Months in Your Home:      
      Full or Shared Custody:         

  • Qualifying Documents must show:

    • The name of the child's parent or guardian
    • The child's home address must match the taxpayers
    • Dates when the child lived with you
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  • I, {primary} acknowledge that the taxpayer has asked me for relevant information to certify that I can claim all listed dependents. Any documents I have, or claim to have, can be supplied to the Tax Preparer or the IRS as requested.

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