Select Filing Status
Note: To claim Head of Household status, you must meet ALL of the following:
Check #1 Check #2 Check #3 Amount
Contributions Select all that apply, followed by its dollar amount. ROTH IRA: Enter Dollar Amount SEP: Enter Dollar Amount Traditional IRA: Enter Dollar Amount Simple Retirement Plan: Enter Dollar Amount Keogh : Enter Dollar Amount
Health Insurance Name*Number of months insured at end of calendar year *Health Insurance ID#
What state were you incorporated in? NY,CT, MA, etc. What is the Date of Incorporation? MM/DD/YYYY What is Date of S-Corp Acceptance? MM/DD/YYYY State ID Number: State ID Number
Direct Deposit AccountBank Account No: account number Routing Number: routing number Name of Bank: Name of Bank Checking Account Savings Account