Tax Return Questionnaire 2022

UNITED COMPETENT TAX SERVICES

INTAKE FORM
Taxpayer Information
Filing Status

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

First NameLast Name
Taxpayer Occupation
Taxpayer SSN*
Numbers only
Taxpayer Date of Birth*

MonthDayYear
Date
Taxpayer Email*
example@example.com
Taxpayer Phone Number*
Taxpayer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Name

First NameLast Name
SSN
Spouse Date of Birth

MonthDayYear
Date
Spouse Occupation
Spouse Phone Number
Spouse Email Address
example@example.com
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DEPENDENTS INFORMATION

	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	SSN
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Do you have a "Special Needs" child?

YesNo
Child/dependent care expenses:
Enter the aggregate amount of advance child tax credit payments you (and your spouse if filing jointly) received.
CHILD CARE (DAYCARE) PAYMENT AMOUNT IN 2024
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

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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
Please upload valid photo ID*

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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:
Should be Empty:

Taxpayer Information