Taxpayer Information

Current Tax Year *

Did you file with us last year? *

Filing Status *

First Name *

Last Name *

Phone *

Email *

Social Security Number *

Street Address *

City *

State *

Country *

Postal Code *

Date of birth *

Are you a U.S. Citizen or green card holder? *

Marital Status *

Occupation *

Are you filing an eligible spouse on your return? *

Are you a full-time student? *

Are you totally and permanently disabled? *

Are you legally blind? *

Is this individual dependent of other? *

Upload Valid State ID or Drivers License *

Upload Social Security Card *

Do you want your return direct deposited? *

Name of Bank *

Bank Routing # *

Bank Account # *

Bank Account Type *

Spouse Name *

Spouse Email *

Spouse Phone *

Spouse's Social Security #

Spouse Date Of Birth *

Date of Death *

Is your Spouse a full-time student? *

Is your Spouse totally and permanently disabled? *

Is your Spouse legally blind? *

Is your Spouse dependent of other? *

Upload Spouse valid State ID or Driver's Lisence *

Upload Spouse Social Security Card *

How many people live with you? *

How many adult? *

How many children? *

Did anyone help support you during the year? *

If yes, who?

How much? $

In case of audit, can you prove financial responsibility and residency for any of the Dependents being claimed? Which document(s) can you provide? (i.e, copy of lease, medical records, school records, snap benefits or benefit statements) *

Upload documents *

Are any of the Dependents being claimed NOT your Son or Daughter? *

If Yes, why are the parent's not claiming the child? (Please explain and list the child's name(s) if more than one is listed on the return) *

Were any of the credits disallowed or reduced in a previous year? *

If yes, please explain:

Did you have any other income during the year? (Child support, alimony) *

If yes, specify

Are any of the dependents that you are claiming disabled? *

If Yes, what is the nature of the disability (permanently and totally disabled or temporarily disabled)?

Does the dependent receive social security/disability benefits? *

If yes, what type?

If yes, how much? $

Dependent Information

List the names below of everyone who lived with you last year (other than your spouse), or anyone you supported but did not live with.

Dependent 1 First Name *

Dependent 1 Date Of Birth *

Dependent 1 Last Name *

Dependent 1 Social Security Number *

Relationship *

How many months did they live in your home for the current year? *

Do you have custody of child? *

Can anyone else claim this dependent? *

Did this dependent attend college this year? *

Do you have documentation proving relationship to the child? *

Dependent 1 Social Security Card *

Dependent 1 Birth Certificate *

Dependent 2 First Name *

Dependent 2 Date Of Birth *

Dependent 2 Last Name *

Dependent 2 Social Security Number *

Dependent 2 Relationship *

Months they live in your home for the current year? *

Do you currently have custody of the child?

Is anyone else eligible to claim this dependent? *

Did this dependent attend college during the year? *

Do you have documents verifying your relationship to the child? *

Upload Dependent 2 Social Security Card *

Upload Dependent 2 Birth Certificate *

By signing below, I hereby certify the information given above is true and correct to the best of my knowledge. I have been informed that claiming a dependent for EITC/CTC/AOTC/HOH or other can result in audit, fines, and penalties if information provided is incorrect.

Client Signature: *

Clear

Date: *

By checking this box, I consent to receive non-marketing text messages from [BUSINESS NAME] about [USE_CASE_FROM_CAMPAIGN_DESCRIPTION]. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.