OFFICE USE ONLY:
Date/Time
S
MJ
MS
HH
QW
Intake: _________________________________________
____________________________________
Preparer: _______________________________________
____________________________________
D/P
QR: __________________________________________
____________________________________
_______________________________________________
____________________________________
Wiesbaden Tax Center Intake/Interview & Quality Review Supplement Sheet
Your full name:
SSN:
1
(as shown on your Social Security or Taxpayer Identification Card)
Date of
Your occupation: Soldier
Other:__________________________
2
birth:
Rank: ___________
(MM DD YY)
Spouse full name:
SSN:
3
(as shown on his/her Social Security or Taxpayer Identification Card)
Date of
Other:__________________________
4
Spouse occupation: Soldier
birth:
Rank: ___________
(MM DD YY)
Contact telephone number(s):
5
Email address:
6
Inquiries and your tax return may be electronically mailed to your email address.
Ret. Servicemember Enlisted Servicemember
Sponsor branch: Army
NAF
DODDS/DODEA
Sponsor grade:
7
Civilian
Warrant Officer
Air Force AAFES
Commissioned Officer
Other: ____________________________
(Check all applicable)
Dependents you supported in 2015
8
(Do not list spouse. IRS will reject return if SSN does not match name.)
> $950 of
Dependent’s Social Security Number or
Date of birth
Relationship to
Dependents’ First and Last name
# of months
unearned
(as shown on
lived with you
INCOME
MM/DD/YYYY
Taxpayer Identification Number
you
their Social Security or Taxpayer Identification Card)
in 2015
IN 2015
Daughter Son
_
_
Other:
1.
Daughter Son
_
_
Other:
2.
Daughter Son
_
_
Other:
3.
Daughter Son
_
_
Other:
4.
A power of attorney or IRS Form 2448 (we must retain a copy of the authorization)
Indicate if you are filing this return with:
9
IRS Form 8332 (claiming a child who does not live with you as a dependent)
State Tax Information
Taxpayer:
10
Resident
Non-resident
Part year resident
State ____________________________________________
11
City: ____________________________ County:_________________ School District:___________________________
12
MM/DD/YYYY
MM/DD/YYYY
Dates lived in the state:
through
13
Spouse:
14
Resident
Non-resident
Part year resident
State ____________________________________________
15
City: ____________________________ County:_________________ School District:___________________________
16
MM/DD/YYYY
MM/DD/YYYY
Dates lived in the state:
through
17
Direct Deposit Information
For direct deposit or payment of tax owed.
Checking
Savings
Your bank account number:______________________________________________
18
Your bank’s nine-digit Routing Transit Number:
19
Privacy Act Statement: AUTHORITY: 10 USC § 3013. PRINCIPAL PURPOSE: To assist the WAAF Tax Center personnel in the preparation and filing of federal and/or state tax returns. ROUTINE USES:
To provide Tax Center personnel with sufficient information to advise on and prepare tax returns. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL BY NOT PROVIDING
INFORMATION: Disclosure is voluntary. Nondisclosure prohibits tax assistance. By requesting income tax return services you authorize Tax Center personnel to retain a copy of this form or other electronic
return information as required by the U.S. Internal Revenue Service. You will not be denied tax preparation services if you do not authorize retention of your tax information. U.S. Army tax preparers and lawyers
are not permitted to give you financial advice or prepare or file a tax return with information they know is incorrect or inconsistent with tax law, and your submission of information does not create an attorney client
relationship with Tax Center personnel. Tax preparation and filing services are free and you owe nothing for these services, however our tax preparation software automatically prepares an invoice showing you
the fair market value of our tax preparation services.