Virtually Essential-Tax Services
Secure Client Tax Information Form
Personal Information
Primary Taxpayer
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Address Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Was this your address last year?
*
Please Select
Yes
No
Prior Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Filing Snapshot
Filing Status
*
Please Select
Single
Head of Household
Married Filing Jointly
Married Filing Separately
Qualifying Widow(er)
Spouse Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Did you file a tax return last year?
*
Please Select
Yes
No
Are you self-employed?
*
Please Select
Yes
No
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Dependents
Please enter details for each dependent you plan to claim.
Did you have any dependents for the 2025 tax year?
*
Please Select
Yes
No
Dependent 1
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Relationship to Taxpayer
*
Please Select
Son/Daughter
Stepchild
Foster Child
Sibling (Brother/Sister)
Parent
Other relative
Non-relative
Not sure
Lived with you more than half the year?
*
Yes
No
Is this a shared custody situation?
*
Yes
No
Add another dependent?
Yes
No
Dependent 2
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Relationship to Taxpayer
*
Please Select
Son
Daughter
Stepchild
Foster child
Brother
Sister
Parent
Grandparent
Grandchild
Other
Lived with you more than half the year?
*
Yes
No
Is this a shared custody situation?
*
Yes
No
Add another dependent?
Yes
No
Dependent 3
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Relationship to Taxpayer
*
Please Select
Son
Daughter
Stepchild
Foster child
Brother
Sister
Parent
Grandparent
Grandchild
Other
Lived with you more than half the year?
*
Yes
No
Is this a shared custody situation?
*
Yes
No
Add another dependent?
Yes
No
Dependent 4
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Relationship to Taxpayer
*
Please Select
Son
Daughter
Stepchild
Foster child
Brother
Sister
Parent
Grandparent
Grandchild
Other
Lived with you more than half the year?
*
Yes
No
Is this a shared custody situation?
*
Yes
No
Add another dependent?
Yes
No
Dependent 5
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Relationship to Taxpayer
*
Please Select
Son
Daughter
Stepchild
Foster child
Brother
Sister
Parent
Grandparent
Grandchild
Other
Lived with you more than half the year?
*
Yes
No
Is this a shared custody situation?
*
Yes
No
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Credits and Situations
Select all that apply
I have children under age 17
I paid for college or education expenses
I pay most of the cost of maintaining my household
I received Earned Income Credit in the past
None of these apply
Anything you'd like us to know about the above?
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Business Information
(Self-Employed Only)
Business Name (or DBA)
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Type
*
Please Select
Sole Proprietor
Single-Member LLC
Partnership
Other
EIN (if applicable)
Primary Business Activity
Did you receive any 1099-NEC forms?
Please Select
Yes
No
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Income Consistency Check
Did you receive any of the following types of income in 2025? (Select all that apply)
Self-employment, gig, or freelance income
Cash income, tips, or side work
Unemployment income
Cryptocurrency transactions
Other income not reported on a W-2 or 1099
None of the above
If applicable, please briefly explain (optional)
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IP PIN
Have you (or your spouse or dependents) been issued an IRS Identity Protection PIN (IP PIN)?
*
Yes
No
Please enter the 6-digit IP PIN(s) issued by the IRS.
Required if issued by the IRS for identity protection
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Identity Verification Upload
Government-Issued Photo ID (FRONT)
*
Browse Files
Drag and drop files here
Choose a file
Please upload a clear photo of your valid driver's license or state ID
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of
Government-Issued Photo ID (BACK)
Browse Files
Drag and drop files here
Choose a file
Please upload a clear photo of your valid driver's license or state ID
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of
Social Security Card
*
Browse Files
Drag and drop files here
Choose a file
Upload a photo or scan of your Social Security card
Cancel
of
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Client Acknowledgment
I certify that all information provided is true and complete to the best of my knowledge. I understand that Virtually Essential will not begin preparing my tax return until all required documents are received and payment is submitted.
*
Primary Taxpayer Signature
Should be Empty: