Taxpayer First Name *

Taxpayer Last Name *

Email *

Address

City *

State *

Postal code *

Phone *

Taxpayer SSN *

Taxpayer DOB *

Taxpayer Driver's License or State ID Number

-License or ID Issue Date

**If you have an Identity Protection Pin (IP Pin) list it here**

Taxpayer Occupation

***What filing status was used on your 2021 tax return? *

Spouse Information (Leave Blank If N/A)

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Address (If Different)

Street Address

City_

State_

Zip Code

Spouse Phone Number

Spouse DOB

Spouse Driver's License or State ID Number

Spouse License or ID Issue Date

Spouse License or ID Expiration Date

**Spouse Identity Protection Pin (IP Pin)**

List Dependents (Include: Full Names, Social Security, Birthdate, Relationship to Taxpayer)

Dependents Identity Protection Pin (Include: Full Name, IP Pin Number)

Can the taxpayer, spouse, or any dependents be claimed by anyone else?

Yes

Were any credits disallowed or reduced in a previous tax year?

Yes

If yes, please explain.

In case of an audit, can you prove residency and responsibility for the dependents being claim?

Do you have supporting documents to prove your relationship to the child

Are any of the dependents disabled?

If yes, what is the nature of the disability? (Permanently and totally disabled or Temporarily)

Would you like to apply for a Refund Advance Loan?

Refund Advance options are discussed in office, and are subject to bank approval...

How would you like to receive your refund? *

Bank Name

Routing Number

Account Number

Type Of Account

Taxpayer agrees that if he/she owes any taxes, prior obligations, or back taxes (offsets), all fees will have to be paid upfront before the return is filed

Did you or your spouse receive unemployment?

Upload 1099-G

Student Acknowledgement

Did you, your spouse, or any dependent receive any post-secondary education?

If yes, upload form 1098-T

1098-T

Did you pay for dependent care to work or look for work?

Supporting Documents

Driver's License/State ID, Social Security Card(s), Birth Certificates

Browses Files

W2, 1099(s), Income and Expenses for Self Employed (Proof of Income)

Browses Files

1098-T, Child Care Forms, any other Government Documents to support the Advanced Child Tax Credit, Economic Impact Payment

Browses Files

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

Your Signature *

Clear

Call, text or email your preparer once form is completed, and all documents are loaded, so that you will be in queue to have your return completed. All services will be provided in the order of which your intake form is received.

Today's Date *