SECTION 1: CLIENT INFORMATION

First Name *

Last Name *

Social Security Number *

Date of birth *

Phone *

Email *

Current Address City, State, ZIP *

How long have you lived at this address? *

Spouse Full Legal Name

Spouse SSN

Spouse Date of Birth

Have you been given an identity theft protection PIN by the IRS? *

If Yes, enter the 6 digit pin

Preparer

SECTION 2: DEPENDENTS

List of Dependents

Dependent 1: Full Name

Dependent 1:SSN

Dependent 1:Date of Birth

Dependent 1:Relationship to you

Dependent 1:Months lived with you during the year

Is Dependent 1 provide over half of their own support?

Yes

No

For Dependent 1: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 1: Who?

For Dependent 1: Do you rotate claiming this dependent with another parent?

Yes

No

Is dependent 1 a full time student?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 1)

If Yes, enter the 6 digit pin (Dependent 1)

Dependent 2:Full Name

Dependent 2 :SSN

Dependent 2:Date of Birth

Dependent 2:Relationship to you

Dependent 2:Months lived with you during the year

Is dependent 2 a full time student?

Yes

No

Is Dependent 2 provide over half of their own support?

Yes

No

For Dependent 2: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 2: Who?

For Dependent 2: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 2)

If Yes, enter the 6 digit pin (Dependent 2)

Dependent 3: Full Name

Dependent 3:SSN

Dependent 3:Date of Birth

Dependent 3:Relationship to you

Dependent 3:Months lived with you during the year

Is dependent 3 a full time student?

Yes

No

Is Dependent 3 provide over half of their own support?

Yes

No

For Dependent 3: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 3: Who?

For Dependent 3: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 3) *

If Yes, enter the 6 digit pin (Dependent 3)

Dependent 4: Full Name

Dependent 4:SSN

Dependent 4:Date of Birth

Dependent 4:Relationship to you

Dependent 4:Months lived with you during the year

Is dependent 4 a full time student?

Yes

No

Is Dependent 4 provide over half of their own support?

Yes

No

For Dependent 4: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 4: Who?

For Dependent 4: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 4)

If Yes, enter the 6 digit pin (Dependent 4)

Dependent 5: Full Name

Dependent 5:SSN

Dependent 5:Date of Birth

Dependent 5:Relationship to you

Dependent 5:Months lived with you during the year

Is dependent 5 a full time student?

Yes

No

Is Dependent 5 provide over half of their own support?

Yes

No

For Dependent 5: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 5: Who?

For Dependent 5: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 5)

If Yes, enter the 6 digit pin (Dependent 5)

Dependent 6: Full Name

Dependent 6:SSN

Dependent 6:Date of Birth

Dependent 6:Relationship to you

Dependent 6:Months lived with you during the year

Is dependent 6 a full time student?

Yes

No

Is Dependent 6 provide over half of their own support?

Yes

No

For Dependent 6: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 6: Who?

For Dependent 6: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 6)

If Yes, enter the 6 digit pin (Dependent 6)

Dependent 7: Full Name

Dependent 7:SSN

Dependent 7:Date of Birth

Dependent 7:Relationship to you

Dependent 7:Months lived with you during the year

Is dependent 7 a full time student?

Yes

No

Is Dependent 7 provide over half of their own support?

Yes

No

For Dependent 7: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 7: Who?

For Dependent 7: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 7)

If Yes, enter the 6 digit pin (Dependent 7)

Dependent 8: Full Name

Dependent 8:SSN

Dependent 8:Date of Birth

Dependent 8:Relationship to you

Dependent 8:Months lived with you during the year

Is dependent 8 a full time student?

Yes

No

Is Dependent 8 provide over half of their own support?

Yes

No

For Dependent 8: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 8: Who?

For Dependent 8: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 8)

If Yes, enter the 6 digit pin (Dependent 8)

Dependent 9: Full Name

Dependent 9:SSN

Dependent 9:Date of Birth

Dependent 9:Relationship to you

Dependent 9:Months lived with you during the year

Is dependent 9 a full time student?

Yes

No

Is Dependent 9 provide over half of their own support?

Yes

No

For Dependent 9: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 9: Who?

For Dependent 9: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 9)

If Yes, enter the 6 digit pin (Dependent 9)

Dependent 10: Full Name

Dependent 10:SSN

Dependent 10:Date of Birth

Dependent 10:Relationship to you

Dependent 10:Months lived with you during the year

Is dependent 10 a full time student?

Yes

No

Is Dependent 10 provide over half of their own support?

Yes

No

For Dependent 10: Can ANYONE ELSE claim this dependent?

Yes

No

For Dependent 10: Who?

For Dependent 10: Do you rotate claiming this dependent with another parent?

Yes

No

Have you been given an identity theft protection PIN by the IRS? (Dependent 10)

If Yes, enter the 6 digit pin (Dependent 10)

SECTION 3: INCOME SOURCES

Check ALL that apply and upload documents where applicable

For Self Employment or Business Income

Yes

No

Upload documents where applicable

Business Name

Business EIN (if any)

Type of Business or Service

Business Start Date

Did you operate more than one business?

Yes

No

Did you receive any 1099 forms?

Yes

No

If no, did you still receive income?

Yes

No

SECTION 4: BUSINESS EXPENSES (Schedule C)

Check all that apply

Do you have receipts or records for these expenses?

Yes

No

Vehicle Used for Business Year, Make, Model

Date placed in service

Total miles driven for the year

Business miles

Personal miles

SECTION 5: EDUCATION

Did you attend college or trade school this year?

Yes

No

Did any dependents attend college?

Yes

No

Did you receive Form 1098-T?

Yes

No

Were tuition or fees paid out of pocket?

Yes

No

SECTION 6: HEALTH INSURANCE

Did you have health insurance for the entire year?

Yes

No

Coverage type

Did you receive Form 1095-A?

Yes

No

SECTION 7: CREDITS & LIFE CHANGES

Did you move during the year?

Yes

No

Did you buy, sell, or refinance a home?

Yes

No

Did you pay childcare expenses?

Yes

No

Did you receive advance child tax credit?

Yes

No

Did you receive any stimulus payments?

Yes

No

Did you have any of the following

SECTION 8: BANKING & REFUND OPTIONS

Preferred Refund Method *

Bank Name

Routing Number

Account Number

Account Type

Checking

Saving

Are you interested in a tax advance if eligible?

Yes

No

SECTION 9: PRIOR YEAR & IRS ISSUES

Did you file a tax return last year? *

Yes

No

If no, what year was the last return filed? *

Do you owe the IRS or state? *

Yes

No

Are you on a payment plan? *

Yes

No

Have you received any IRS or state letters? *

Yes

No

I certify that the information provided is true and complete to the best of my knowledge. I understand that providing false or incomplete information may delay my return or result in penalties.

Date *

Signature *

Clear