Appointment preference:
*
I would like to file my taxes in-person.
I would like to file my taxes via Zoom.
Your Name
*
First Name
Last Name
Home Phone Number:
Please enter a valid phone number.
Mobile Number
*
Your E-mail Address
*
example@example.com
Social Security Number:
*
Date of Birth:
*
-
Month
-
Day
Year
Date
Primary Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Monthly Rent/Mortgage:
*
Filing Status:
*
Single
Married
Legally Separated
Widowed
Dependents Name, D.O.B and Social Security No:
*
Occupation:
*
Do you receive food stamps/SNAP?
*
Yes
No
Type of health insurance:
*
Was this insurance purchased through the market place (Affordable Care Act) yes or no:
*
Yes
No
Did you file your taxes in 2024?
*
Yes
No
What was your 2024 Adjusted Gross Income (AGI)?
*
Direct Deposit Form
Name of bank/financial institution:
*
Bank 9-digit routing number:
*
Consent/Signature
I attest that the income and personal information provided in this form are true. I understand that falsification of my income is grounds for termination of Tax Preparation Services rendered by The Campaign Against Hunger. If you have questions or concerns regarding this form, please contact Daniel Wright, Benefits Specialist at dwright@tcahnyc.org.
Name
*
First Name
Last Name
Signature
*
Signature Date:
*
-
Month
-
Day
Year
Date
Please upload the applicable documentation that will be needed to process your application.
Photo ID
Social Security Card
W2 from employer
1099 from Social Security
1099R from Pension Annuities
1099INT Bank Interest
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