CLIENT
I NFORMATION
S HEET
(MUST
B E
F ILLED
O UT
C OMPLETELY)
_____
F iled
w ith
o ur
f irm
l ast
y ear
Date
_ ____________________
_____
N ew
C lient
_ _________-‐-‐-‐______-‐-‐-‐____________
_ __________-‐-‐-‐______-‐-‐-‐___________
T axpayer’s
S ocial
S ecurity
#
S pouse’s
S ocial
S ecurity
#
____________________________________
_ ___
_ ___________________________________
_ ___
Taxpayer’s
F irst
N ame
M .I.
S pouse’s
F irst
N ame
M .I.
____________________________________
_ ___
_______________________________________________
Taxpayer’s
L ast
N ame
S uffix
Spouse’s
L ast
N ame
( if
d ifferent)
______________________________________________
_______________________________________________
Present
S treet
A ddress
City,
S tate,
Z ip
C ode
______________________________________________
_______________________________________________
Taxpayer’s
E -‐Mail
A ddress
Spouse’s
E -‐Mail
A ddress
_______/_______/____________
_______/_______/____________
Taxpayer’s
D ate
o f
B irth
Spouse’s
D ate
o f
B irth
______________________________________________
_______________________________________________
Taxpayer’s
O ccupation
Spouse’s
O ccupation
______________________________
_ ______________________________
_ _______________________________
Taxpayer’s
C ell
P hone
H ome
o r
A lternate
P hone
S pouse’s
C ell
P hone
________________________________
_ _______________________________
_ _______________________________
FILING
S TATUS
____
S ingle
_ ____
M arried
F iling
J oint
_ ____
M arried
F iling
S eparate
_ ____
H ead
o f
H ousehold
_ ____
Q ualifying
W idower
Are
y ou
b eing
c laimed
o n
a nother
p erson’s
t ax
r eturn?
_ _______Yes
_ ______NO
DEPENDENTS
F irst
N ame
L ast
N ame
D ate
o f
B irth
Social
S ecurity
#
Relationship
__________________
_ _________________
_ ____/_____/_______
_ ______/_____/_________
_ ____________________
__________________
_ _________________
_ ____/_____/_______
_ ______/_____/_________
_ ____________________
__________________
_ _________________
_ ____/_____/_______
_ ______/_____/_________
_ ____________________
__________________
_ _________________
_ ____/_____/_______
_ ______/_____/_________
_ ____________________
DEPENDENT
C ARE
E XPENSES
D ependent’s
N ame
Name
&
A ddress
o f
P rovider
F ederal
I D#
A mount
P aid
____________________
_ ________________________________________________
_ ________________
_ ____________
____________________
_ ________________________________________________
_ ________________
_ ____________
____________________
_ ________________________________________________
_ ________________
_ ____________
COLLEGE
E XPENSES
a
b
S tudent’s
N ame
U /G
N ame
&
A ddress
o f
C ollege
Amount
P aid
____________________
_ ____
_ ________________________________________________________
_ ____________
____________________
_ ____
_ ________________________________________________________
_ ____________
____________________
_ ____
_ ________________________________________________________
_ ____________
a
U
=
U ndergraduate
S tudent
( First
4
y ears
o f
c ollege)
a
G
=
G raduate
S tudent
( Education
b eyond
a
4 -‐year
d egree)
b
Amount
P aid
i ncludes:
T uition,
B ooks
&
F ees
( Do
n ot
i nclude
R oom
&
B oard)