Household Income Employee Affidavit

Household Employee Income Affidavit

Please complete this form if you or your spouse (if married filing jointly) are hired by individuals to perform household services in their homes. *Please note that you may be required by a taxing authority to prove the legality of your income, please keep any & all documentation pertaining to all household income you are claiming, in the event of an audit, you will have to prove every item you have listed on this form. You hereby certify that the information on this form is accurate and true (please refer to your Client Engagement Letter between you and Your Tax Angels-Jordan & Associates, LLC If you are unsure of the accuracy of your calculations and would like for us to provide you with bookkeeping services at a rate of $75.00 per hour let us know, if not, please initial here _______ indicating your waiver of our bookkeeping services*
Initials

Clear
Tax Payer

First NameLast Name
Spouse (if Married Filing Jointly)

First NameLast Name
How many people pay you to perform services in their homes?
What type of services are you providing to them?

Babysitting/NannyCleaning/MaidHandymanDriverCooking/Meal PreparationLawn MaintainenceHousesittingOther
Yearly payments received from Household Employers:
Employer 1
Employer 2
Employer 3
Employer 4
Employer 5
Employer 6
Employer 7
Employer 8
Employer 9
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: