Bee Square Tax Service New Client Form
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1INTERNAL USE ONLY!
Bee Square Tax Service
QB _____
PS _____
Print Form
New Client Form
CM _____
Refered by . . . . . . . . . . . . .
Personal Information
Spouse:
Taxpayer:
Last Name
. . . . . . . . . . . . . . . .
Last Name
. . . . . . . . . . . . . . . .
First Name
First Name
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
Middle Initial
Suffix
Middle Initial
Suffix
. . . . . . . . . . . .
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. . . . . . . . . . . . . .
. . . . . . . .
Social Security No.
Social Security No.
. . . . . .
. . . . . . . .
Occupation
Occupation
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
Date of Birth
(mm/dd/yyyy)
Date of Birth
(mm/dd/yyyy)
. . . . . . . . . . . .
. . . . . . . . . . . . . .
or Age as of 1/1/2006
or Age as of 1/1/2006
. . . .
. . . . . .
E-mail Address
E-mail Address
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. . . . . . . . . . . .
Work Phone
Ext
Work Phone
Ext
. . . . . .
. . . . .
. . . . . .
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Cell Phone
Cell Phone
. . . . . . .
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Home Phone
Fax Number
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. . . . . . . . . . . .
Address
Apt No.
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.
City
State
ZIP Code
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No
Yes
G
Do you want $3 to go to the Presidential Election Campaign Fund?
Taxpayer
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .
No
Yes
G
Spouse
. . . . . .
Dependents (or persons living in your household), if more than three use the back of this sheet.
Name
Date of birth
Social Security #
Name
Date of birth
Social Security #
-
-
Name
Date of birth
Social Security #
-
-
Would you like to have your refund deposited or balance due withdrawn electronically to/from your bank account:
REFUND - Deposit my refund to my bank account. I have provided a cancelled check to verify the account information.
DUE - I authorize the IRS to withdraw the amount due. I have provided a cancelled check to verify the account information.
W- 2s enclosed:
If no, explain:
Yes
No
Number of W- 2's:
Other documents enclosed (Forms 1098, 1099, etc.):
Yes
No
State of residence:
Did you live and work the entire year in this state?
Yes
No
If no, list other states & Dates:
Information for the Earned Income Credit Only:
The questions below must be answered to calculate EIC.
G
Is the taxpayer or spouse a qualifying child for EIC for another person?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
Was the taxpayer's (and spouse's if married filing jointly) home in the United States for more than half of 2005?
Yes
No
. . . . . . . . . .
If the SSN of either taxpayer or spouse was obtained to get a federally funded benefit, such as Medicaid, and the
G
Social Security card contains the legend Not Valid for Employment, check this box (see Help)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
Check if taxpayer is filing head of household and lived with nonresident alien spouse during the last six months of 2005
. . . . . . . . . . . . . .
G
Check if EIC was disallowed or reduced in a previous year and taxpayer is required to file Form 8862
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
Check if EIC was notified by the IRS that EIC cannot be claimed in 2005
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Anything else that may be useful in preparing your taxes (deductions, contributions, medical expenses)
Please include any questions for your tax professional on the back of this sheet
Bring this sheet with you or fax it to: BEE SQUARE TAX SERVICES 407-851-4037
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