Dynisty’s Tax Service Client Forms

CUSTOMER DATA SHEET

DTS
PLEASE FILL OUT THIS FORM COMPLETELY; ASK FOR HELP IF NECESSARY
Please select one

New ClientReturning Client
Full Name*
Primary Filer's Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN*
DOB*
Email*
Cell*
Spouse's Full Name
Spouse Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN
Spouse Information
DOB
Spouse Information
Cell
Spouse Information
Email
Spouse Information
DEPENDENT(S) INFORMATION AS IT IS EXACTLY ON SOCIAL SECURITY CARD

Type a question*

	Full Name	DOB	SSN	Months Stayed	Realtionship
1.
2.
3.
4.
5.
6.
7.
8.
9.

Source Of Income
1. # OF W 2s
2. Unemployment (Form 1099 G) 3. Alimony
3. Alimony
4. Pension Income (Form 1099R)
5. Social Security Benefits (SSA 1099)
6. Interest Income (Form 1099 INT)
7. Child Support
8. Lottery/Gambling
9. Self Employment
Please type Yes or NO
10. Any other income
If yes Please list it here
Please upload all Documents such as ID, SSN Cards (Birth Certificates ETC If you have business documents (Ein, LLC, State Registry) W2 1099s*

Cancelof
1. DID YOU PAID ALIMONY?

YesNo
2. DID YOU MAKE IRA CONTRIBUTION

YesNo
3. DID YOU BUY SELL OR REFINANCE A PERSONAL HOME?

YesNo
4. DID YOU PAY TUITION EXPENSES?

YesNo
5. (FORM 1098-T) STUDENT LOAN INTEREST?

YesNo
Childcare Information
Name of provider
If you are filing with a specific Tax Agent please select thier name

Stacey ColemanShuntay CargileDominique ShippNext Available Agent
DEPENDENT CLAIM WAIVER

DTS
I do hereby certify that I have the right to claim the dependent(s) listed on my tax return. I will not hold Dynisty's Tax Service or its employees liable for any of the dependents I have named on my tax return. I will be able to provide proof upon request if needed.
Full Name *
Please type full name
Do u have custody of the dependent(s) listed on your tax return*
If No please give reason
If you are not Biological parent(s), do you have authority to use the dependent(s) listed on your tax return?*
If No, please explain:
Are there anyone other than you who may claim the dependent(s) listed on your return?*
Can anybody claim you as a dependent on their tax return?*
If Yes, please list whom and relationship
METHOD OF PAYMENT

All fee's will be withheld from whichever refunds (state or federal) comes first !
Please complete every part of document; ask for help if you need to.
Please select payment method*

Direct DepositCheck or Money OrderPre-paid Visa Debit cardPaper return fees must be paid upfront

Please answer all questions below......*

	yes or no
Do you have any outstanding Federal Tax Liabilities?
Do you have any other liabilities such as child support or student loans?
Do you give us permission to check for any outstanding tax liabilities ? (If no then your payment will be due upfront )

I do authorize Dynisty's Tax Service prepare my Tax Return, Please Initial below*
Put first and last name initial above!

Please enter Direct Deposit Information below

	Banking Information
Routing
Account

By signing this form, I am agreeing that everything entered on it is correct and true. Dynisty's Tax Service is not liable for any false information given.
NOTE: IF YOUR REFUND IS RECEIVED WITH IN THE EXPECTED TIME FRAME, PLEASE CALL THE IRS @ 1800-829-1040

Due to the PRIVACY ACT, ONLY you can request information on the status of your return from the IRS.
DISCLAIMER STATEMENT

DTS
By signing this form, I am agreeing that everyhting entered on it is correct and true. Dynisty's Tax Service is not liable for any false information given.
Please contact the IRS via www.irs.gov or 1-800-829-1040 to check the status of your returns.

Due to the PRIVATE ACT, only you can check the status of your return.
LETTER OF ENGAGEMENT PREPARE TAX RETURN
The undersigned person(s) has/have authorized the Dynisty’s Tax Service and its authorized representative in Person of *

First NameLast Name
to prepare their federal and state tax returns. The company claims no responsilbilty for the tax return(s) other than preparing the said return(s). The accurancy of the return(s) will be directly related to the information provided by the tax payer(s). The information recieved by the company wil be use in accordance with the rules and regulation of the Internal Revenue Service (IRS).

I agree to electronacially sign any document that may require a signature to complete my tax return. I will make two forms of ID avaliable, one of which will include my SSN card. If required , I will also make the following documents (W-2, 1099, 1098, child care inforamtion , school inforamtion, mortgage information ETC) should be given to the preparer. We will provide you with a copy of your retun(S) and advice you to have to contact the IRS to get any needed copy.

Dynistys Tax Service does not determine when your tax return will be remitted; Please use WWW.IRS.GOV to know when your refund will be released.

By signing the engagement letter, I have agreed to fully compensate and authorize Dynisty's Tax Service is hereby permitted to electronically deduct its compnsation as soon as my return is released .
Alternate Eligibility Record (Due Diligence)

In accordance with Internal Revenue Service (IRS) Bulletin 97-65 and Internal Revenue Code (IRC), this form serves as Alternate Eligibility Checklist, and may be used IN LIEU of others of Due Diliegence, including form 8867 Maintain this form with your clients files .
Head Of Household Eligibility

You may file Head of Household if you can answer YES to ALL the following questions. (See publication 17 Chap 2&3)

	Yes Or No
You are unmarried, or are considered unmarried on the last day of the year?
You paid more than half the cost of keeping up a home for the year
A qualifying person (Definition below) lived with you in the same home for more than half the year (except temporary absences, such as school) and you can claim an exemption for him/her except as noted under Category 3 below

Qualifying person requirements are: (See table 2.1 Publication 17)

1. A qualifying relative such as a parent, grandparent, brother, sister, stepbrother, stepsister, stepmother, stepfather, father-in-law, half-brother, half-sister, brother-in-law, sister-in-law, daughter-in-law,uncle, aunt, nephew, or neice who is related to you by blood and lived with you the entire year.

2. Child, Grandchild, stepchild, or adopted child.

3. Eligible foster child ( Note. For eligbilty for dependnet only a foster child is a child who is in your care, that you care for as your own child and who lived with you the entire year, it does not matter how the child became a member of the household)
EARNED INCOME CREDIT (EIC) ELGIBILTY

You may claim the EIC if you can answer YES to ALL 4 tests below (See publications 17 Chapter 36)

	Yes or No
1. Relationship Test Your child/children is/are one of the following: a son, daughter, adopted child, stepchild, grandchild, or eligible foster child or is your brother, sister, stepbrother, stepsister, (or the child or grandchild of your brother, sister, stepbrother, or stepsister) and you care for it/them as you would your own child.
2. Age Test Your child/children is/are under 19 years of age at the end of the year or is under 24 years of age at the end of the year and is a full-time student or was permanently and totally disabled at any time during the tax year, regardless of age.
3. Residency Test Your child/children lived with you for more than half the year (or the whole year if an eligible foster child)
Your home is located in the United States
4. Qualifying child or another Test If your child/children is/are the qualifying child/children of another individual, you are the only person claiming the credit for that/those child/children during the tax year. (Note: If the answer is NO, refer to the tiebracker rule, You may still be able to take the credit.

FOSTER CHILD ELIGIBILTY

The definition of a foster child has changed establishing elgilbiltly for dependency see above (For establishing for the child tax credit you must answer YES to ALL the questions below)

	Yes or No
You cared for the child/children as you would your own child
The child/children lived with you for the entire year except for temporary absences
The child/children was/were placed in your care by a state, one subdivision,or placement agency

I attest and affirm that the information provided to compare this Eligibilty Checklist is true and correct to the best of my knowledge, I understand the IRS may randomly question eligbilyt and that if my tax return is randomly selected for review, that my return, refund, direct deposit, or any combination thereof may be delayed or denied.
Tax Payer Signature*

Clear
Todays Date *

MonthDayYear
Date
Spouse's Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

CUSTOMER DATA SHEET

PLEASE FILL OUT THIS FORM COMPLETELY; ASK FOR HELP IF NECESSARY

DEPENDENT(S) INFORMATION AS IT IS EXACTLY ON SOCIAL SECURITY CARD

Source Of Income

DEPENDENT CLAIM WAIVER

METHOD OF PAYMENT

DISCLAIMER STATEMENT

LETTER OF ENGAGEMENT PREPARE TAX RETURN

Alternate Eligibility Record (Due Diligence)

Head Of Household Eligibility

EARNED INCOME CREDIT (EIC) ELGIBILTY

FOSTER CHILD ELIGIBILTY