Social Security Number *

Mailing Address if Different

Citizenship Status *

Spouse Full Legal Name *

Spouse Date of Birth *

Spouse Social Security Number *

Spouse Phone Number *

Spouse Email Address *

Taxpayer Government Issued ID *

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Spouse Government Issued ID *

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Social Security Cards for Everyone on Return *

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Prior Year Tax Return (Optional)

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How many dependents do you have? *

Dependent 1 Full Name *

Dependent 1 Date of Birth *

Dependent 1 Social Security Number *

Dependent 1’s Relationship to You *

Months Dependent 1 Lived With You This Year ✅ *

Is Dependent 1 a full-time student? *

Yes

Is Dependent 1 disabled? *

Yes

Dependent 1 Birth Certificate *

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Dependent 1 Social Security Card *

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Dependent 1 School or Medical Residency Documents *

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Dependent 1 Court or Guardianship Documents (if applicable)

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Dependent 2 Full Name *

Dependent 2 Date of Birth *

Dependent 2 Social Security Number *

Dependent 2’s Relationship to You *

Months Dependent 2 Lived With You This Year *

Is Dependent 2 a full-time student? *

Yes

Is Dependent 2 disabled? *

Yes

Dependent 2 Birth Certificate *

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Dependent 2 Social Security Card *

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Dependent 2 School or Medical Residency Documents *

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Dependent 2 Court or Guardianship Documents (if applicable)

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Dependent 3 Full Name *

Dependent 3 Date of Birth *

Dependent 3 Social Security Number *

Dependent 3’s Relationship to You *

Months Dependent 3 Lived With You This Year *

Is Dependent 3 a full-time student? *

Yes

Is Dependent 3 disabled? *

Yes

Dependent 3 Birth Certificate *

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Dependent 3 Social Security Card *

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Dependent 3 School or Medical Residency Documents *

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Dependent 3 Court or Guardianship Documents (if applicable)

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Dependent 4 Full Name *

Dependent 4 Date of Birth *

Dependent 4 Social Security Number *

Dependent 4’s Relationship to You *

Months Dependent 4 Lived With You This Year *

Is Dependent 4 a full-time student? *

Yes

Is Dependent 4 disabled? *

Yes

Dependent 4 Birth Certificate *

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Dependent 4 Social Security Card *

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Dependent 4 School or Medical Residency Documents *

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Dependent 4 Court or Guardianship Documents (if applicable)

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Dependent 5 Full Name *

Dependent 5 Date of Birth *

Dependent 5 Social Security Number *

Dependent 5’s Relationship to You *

Months Dependent 5 Lived With You This Year *

Is Dependent 5 a full-time student? *

Yes

Is Dependent 5 disabled? *

Yes

Dependent 5 Birth Certificate *

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Dependent 5 Social Security Card *

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Dependent 5 School or Medical Residency Documents *

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Dependent 5 Court or Guardianship Documents (if applicable)

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Number of W2 Forms Received

Upload multiple W-2 forms

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Describe Your Self Employment or Side Business

Employer Identification Number (EIN)

Bookkeeping Method or Notes

Upload all Form 1099-NEC and Form 1099-MISC documents

Upload your 1099-NEC and 1099-MISC forms here

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Upload Income Log or Bookkeeping Records

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Upload Profit and Loss Statement

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Gig Work Income *

Upload Gig Work 1099 or Year-End Statements

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Other Income Types

Upload Other Income Supporting Documents

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Upload 1098 T Form

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Upload Tuition Receipts

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Upload Student Loan Interest (1098 E)

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What is the child care provider’s name?

What is the child care provider’s phone number?

What is the child care provider’s address?

What is the child care provider’s Tax ID?

What is the total amount paid for child care?

Summary of Medical Dental and Prescription Expenses

Upload 1098 Mortgage Interest

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Upload Property Tax Statement

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Upload Closing Documents

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List Cash and Non Cash Donations

1
2
3
4
5
6

Upload Donation Receipts

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IRA and Additional Retirement Contributions

Upload Solar or Energy Credit Documentation

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Are you self-employed or a business owner?

Yes

Entity Type *

LLC

S Corp

Partnership

Sole Proprietor

Date Business Was Formed

Upload Articles of Organization

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Upload Prior Year Business Tax Return

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Upload Operating Agreement

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Profit and Loss Statement

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Balance Sheet

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Business Bank Statements

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Payroll Reports

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1099s You Issued

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Inventory or Asset Purchase Receipts

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Total Home Square Footage

Square Footage Used for Business

List Home Expenses (rent mortgage utilities internet repairs etc.)

Did you obtain health insurance coverage from any of the health exchanges Marketplace? (1095A)

Yes

Upload 1095-A Form *

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Did You Have Marketplace Health Insurance

Yes

Refund Method

Direct Deposit

Paper Check

Account Type (Checking/Savings)

Upload Voided Check or Bank Letter

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Did your address change this year?

Yes

Did you receive any IRS or state letters?

Yes

Have you been a victim of identity theft?

Yes

Did you make estimated tax payments?

Yes

Do you owe back taxes child support or student loans?

Yes

Does someone else claim you?

Yes

Did you buy sell or trade cryptocurrency?

Yes

Did you win or lose gambling?

Yes

Did you buy or sell a home?

Yes

Upload IRS or State Notices

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Additional Notes or Information

Client Acknowledgements *

I confirm all information I provided is accurate

I understand Financial Dominance does not audit or verify information

I am responsible for reviewing my tax return before filing

I understand fees must be paid before filing

I understand incomplete information may cause delays penalties or interest

I agree to upload all required documents to the secure portal

I consent to communication by phone email text message and portal

Required Checkbox *

I certify that all information and documents I have provided are true correct and complete to the best of my knowledge and belief

Taxpayer Digital Signature *

Clear

Spouse Digital Signature (If Applicable)

Clear