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Tax Preparer Name (Optional)
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Anyone
Myosha
Edward
Jazmin
Chris
Ashley
Jazzie
Shama
How Did You Hear About Us? (Referred by Anyone)
How Much Was Your Tax Refund Last Year?
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Did You Want An Estimate or To File Your Taxes?
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Just an Estimate
File My Taxes
I would like you to give me an estimate then file my taxes
What is your occupation?
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Did You or Any of Your Dependents Receive an Identity Theft Pin? Yes or No? If yes, please type the PIN number below.
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Taxpayer Name
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Birth Date
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Month
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Day
Year
Date
Social Security Number
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Email
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example@example.com
Home Phone
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Area Code
Phone Number
Filing Status
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Single
Head of Household
Married Filing Separate
Married Filing Jointly
Widowed
Current Address
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Do you need any other services besides tax preparation?
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Life Insurance policy as low $20 a month, which includes products for financial planning, college planning etc.
Dental, Vision or Hearing
Health Insurance
Credit Repair Assistance
I don't need anything else
SPOUSE INFORMATION
Only fill this section out if you are filing with your spouse.
Spouse Name
Spouse Birth Date
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Month
-
Day
Year
Spouse Social Security Number
Email
example@example.com
Phone Number
Spouse Occupation
DEPENDENT INFORMATION
Only fill this section out if you are filing with dependents.
Dependent 1
First Name
Middle Name
Last Name
Dependent 1 Birth Date
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Month
-
Day
Year
Date
Dependent 1 SSN
Relationship
Months in Home
Dependent 2
First Name
Middle Name
Last Name
Dependent 2 Birth Date
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Month
-
Day
Year
Date
Dependent 2 SSN
Relationship
Months in Home
Dependent 3
First Name
Middle Name
Last Name
Dependent 3 Birth Date
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Month
-
Day
Year
Date
Dependent 3 SSN
Relationship
Months in Home
Dependent 4
First Name
Middle Name
Last Name
Dependent 4 Birth Date
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Month
-
Day
Year
Date
Dependent 4 SSN
Relationship
Months in Home
Dependent 5
First Name
Middle Name
Last Name
Dependent 5 Birth Date
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Month
-
Day
Year
Date
Dependent 5 SSN
Relationship
Months in Home
Did you have any childcare expenses? If so, please include the daycare name, amount, and address. If you had a babysitter, we will need the name, social, and address of the person.
IDENTIFICATION AND INCOME
Only fill this section out if you have a qualifying dependent and will be claiming them on your tax return
TAXPAYER: Please attach a photo of ID.
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TAXPAYER: Please attach a photo of your Social Security Card
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Spouse: Please attach a photo of ID.
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Spouse: Please attach a photo of your Social Security Card
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Dependents: Please attach a photo of the dependents social and Birth Certificate(s)
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Did you or your spouse have Marketplace Insurance?
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Marketplace Form - 1095-A
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Did anyone on your tax return, including yourself, receive unemployment? If so, please attach your 1099-G. If you have any questions in regards to this email us at info@porterietaxsolutions.com
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Unemployment Form - 1099G
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Were you in college? If so, what is the name of the school, the address, and how much was classes, books and supplies?
Upload School Form 1098-T Here (If Received)
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Tax Payer Last Check Stub, W2's and/or 1099
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Spouse W2's and/or 1099
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Other Tax Related Documents(Including business expenses)
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Refund Method
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Check
Direct Deposit
Direct Deposit Info (Please include Routing and Account Number. This is ONLY if you want direct deposit)
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Additional Comments, statements, questions that you think I should know?
Please include as much detail as possible. For example, if you had business expenses, list the type of expense and the amount right next to it.
Signature
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By signing this document you ensure that you are only submitting documents that pertain to your personal taxes and you give Porterie Tax Solutions the permission to give an estimate and/or file your taxes. You also agree to and have read the Consent to Use and Consent Disclosure.
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