Optimum Shield Tax Services Tax Form

OPTIMUM SHIELD TAX SERVICES
Taxpayer Information
Marital Status

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er) with Dependent Children
Taxpayer Name

First NameLast Name
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer SSN
Taxpayer Phone Number
Format: (000) 000-0000.
Taxpayer Occupation
Taxpayer Email Address
example@example.com
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse SSN
Spouse Occupation
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Phone Number
Format: (000) 000-0000.
Spouse Email Address
example@example.com
HEALTH INSURANCE COVERAGE:
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A
Please upload 1095A

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Wages and Salaries (Attach W-2's)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
File Upload

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Were you, your spouse, or any dependent registered in college? Do you have a form 1098T?
File Upload(1098T)

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If you would like your tax refund (if any) deposited directly into your bank

CheckingSavings
Bank Name
Your Account Number
Bank Routing Number
Upload Valid ID

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Rental & Royalty Income and Expense (Rental Property) if any:
Property Type

ResidentialCommercial
Number of days rented
Number of days used personally
Property is owned by

TaxpayerSpouseJoint
Percentage ownership of not 100%: Please indicate if income and expenses below are listed at 100% or your percentage

YesNo
Percentage ownership of not 100%
Did you live in part of the rental property?
If yes, what percentage did you occupy as a tenant?
Business Income & Expenses (Sole Proprietorship, LLC)
Owner Name

First NameLast Name
Business Type

Type a question

Rows	Name of Business	EIN	State of Formation	Year of Formation
Business 1
Business 2
Business 3
Business 4

Business Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you use any part of your home regularly and exclusively for business?

YesNo
Please upload Business tax documents. E.g EIN Letter, Business Expenses Etc

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Please upload any additional tax documents below:

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Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:

DEPENDENTS INFORMATION

Rows	FULL DEPENDENT NAME	DATE OF BIRTH	SSN	GENDER	RELATIONSHIP
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Should be Empty:

OPTIMUM SHIELD TAX SERVICES

Taxpayer Information

HEALTH INSURANCE COVERAGE: