Client Info Sheet
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1
2The Tax Place
clIeNT INFORMaTION
PRIMARY NAME
SPOUSE NAME
SSN
BIRTHDATE
SSN
BIRTHDATE
OCCUPATION
OCCUPATION
PHONE
PHONE
EMAIL
EMAIL
ADDRESS
APT#
CITY
STATE
ZIP
DID YOU MOVE THIS YEAR?
YES
NO
# MONTHS
DEPENDENTS NAME
LIVED WITH YOU
BIRTHDATE
SSN
RELATIONSHIP
LAST YEAR?
(FIRST, INITIAL, AND LAST)
LIVING ARRANGEMENTS
LIVE WITH OTHERS / NO COST
RENT:
# OF MONTHS:
LANDLORD’S NAME:
OWN: IS THE HOUSE IN YOUR NAME?
YES
NO
AMOUNT OF PROPERTY TAXES PAID:
INSURANCE INFORMATION
DID EVERYONE YOU ARE CLAIMING ON YOUR TAX RETURN HAVE HEALTH INSURANCE FOR THE ENTIRE YEAR?
YES
NO
IF YES, SELECT ALL THAT APPLY:
EMPLOYER
MARKETPLACE
INDIVIDUAL
MEDICARE
MEDICAID / HHW / HIP
TRICARE / VA BENEFITS
IF NO, PLEASE LIST ACA EXEMPTION CERTIFICATE NUMBER IF APPLICABLE?
REFUND & DELIVERY SELECTION -
*EXTRA FEES APPLY FOR ALL BANK PRODUCT SELECTIONS
IRS DIRECT DEPOSIT
IRS CHECK
BANK PRODUCT: AMEX CARD*
BANK PRODUCT: DIRECT DEPOSIT*
BANK PRODUCT: CHECK*
DIRECT DEPOSIT INFO:
CHECKING
SAVINGS RTN
ACCT #
WOULD YOU LIKE YOUR TAX RETURN DELIVERED VIA:
PAPER COPY
PDF COPY VIA EMAIL
I CERTIFY THAT I WOULD LIKE MY TAXES PREPARED ACCORDING TO THE INFORMATION SUPPLIED ABOVE. ALL INFORMATION IS TRUE AND
CORRECT AND I TAKE FULL RESPONSIBILITY FOR THE INFORMATION PROVIDED AND THE FINAL PRODUCT AS I DIRECT IT TO BE FILED.
SIGNATURE
DATE
SIGNATURE
DATE
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