Laza Solutions Tax Intake Form

TAX ESTIMATOR FORM

PLEASE NOTE: This is just for an estimate. In order to E-File you have to sign your Tax Return Documents
If someone referred you, please type his or her name here.
Did you file a tax return last year?*

YesNoUnsure
Upload last year's tax return

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Last Year Tax Return Cancelof
What was your last year's AGI (Adjusted Gross Income)
Tax Payers Name*

First NameLast Name
Taxpayer's Email Address*
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Taxpayer's Job Title*
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's SSN*
Example: xxx-xx-xxxx
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Can someone else claim you as a dependent?*

YesNo
What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouse
Did you and your spouse live apart during the year?

YesNoNot Applicable
If yes, did you live together at any time after June 30th

YesNoNot Applicable
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Job Title
Are you trying to buy a new home within the next year?*

YesNo
Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo
Are you on any Government Assistance*

YesNoNot Applicable
Did you support a child or family member for more than 6 months out of the year?*

YesNo
How many dependents are you claiming?*
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, mother, etc.)?
How many months did Dependent #1 live with you last year? (If all year, enter 12)
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2s SSN
Example: xxx-xx-xxxx
How many months did Dependent #2 live with you last year? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you last year? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, mother, etc.)?
How many months did Dependent #4 live with you last year? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here.

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If you do not have a daycare form, please provide Name, Address, and EIN/ SSN and amount paid for childcare:
If requested by the IRS, do you have documentation (i.e. receipts, records) to substantiate your eligibility for the Child Tax Credit, Earned Income Tax Credit and/or Head of Household Filing Status?*

YesNo
Are you self employed?*

YesNo
What is your business name?
What type of business do you have or what type of services do you provide?
Provide a copy of your Business EIN.

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Upload a copy of your DBA or LLC Certificate.

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Did you own livestock or participate in trail ride groups?

YesNoOther
Did you have health insurance last year?

YesNo
Was your insurance through:

Your EmployerMedicaidAffordable Care Act (the healthcare.gov marketplace)Other
Upload Taxpayer & Dependent(s)Insurance Document- 1095-A (if applicable)

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Have you ever been denied the Earned Tax Credit (EITC)?*

YesNo
Were you or any of your dependents in college last year?*

YesNo
Do you have a 1098-T Form from a college for either you or your dependents?

YesNo
Did you trade any Virtual Currency

YesNo
Did you own or rent your home last year?

RentOwnNot Applicable
Monthly Rent/ Mortgage
Amount paid monthly in rent or mortgage
Anything else we should know to prepare your taxes?
Taxpayer's and Driver's License

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Spouse's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S/

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If you have a 1098-T form, upload it here.

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Self-Employment Expense Log, Summary of Income, Business License, Bank Statements, receipts, etc

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

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Additional Documents

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How would you like to receive your tax refund?*

CheckDirect Deposit
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Do you want to request a Refund Advance Loan?*

YesNo
Primary Taxpayer's Signature*

Clear
Spouse's Signature

Clear
Date

MonthDayYear
Date
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TAX ESTIMATOR FORM