Client Information Sheet
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1
29745 Prospect Avenue, Suite 204
Santee, CA 92071
(619) 258-2033
Fax (619) 258-2044
Tax & Financial
CLIENT INFORMATION SHEET
Pursuant a legislative act, we are required to maintain a copy of your driver’s license in our office. Please provide
your driver’s license to the front desk upon completion of this form. Thank you!
_______________________________________________________ FIRST NAME:_________________________________
LAST NAME:
CELL #: ___________________________________
___________________________________________________
E-MAIL ADDRESS
DRIVER’S LICENSE #:
______________________
______________
_____________________________
SOCIAL SECURITY #:
BIRTHDATE:
: ________________________________
________________________
__________________
EMPLOYERS NAME
OCCUPATION:
WORK #:
______________________________________ FIRST NAME:_________________________________
SPOUSE LAST NAME (if different):
CELL #: ___________________________________
______________________________________________________
E-MAIL ADDRESS:
DRIVER’S LICENSE #:
______________________
_______________
____________________________
SOCIAL SECURITY #:
BIRTHDATE:
: ________________________________
________________________
___________________
EMPLOYERS NAME
OCCUPATION:
WORK #:
___________________________________
PHONE # - HOME:
_______________________________________________________________________________________________
MAILING ADDRESS:
_____________________________________________________________________________________________________
CITY, ST, ZIP:
(if different):____________________________________________________________________________________
PHYSICAL ADDRESS
_____________________________________________________________________________________________________
CITY, ST, ZIP:
DEPENDENTS:
NAME _________________________________ RELATIONSHIP ________________ DATE OF BIRTH _____________ SOCIAL SECURITY # ___________________
NAME _________________________________ RELATIONSHIP ________________ DATE OF BIRTH _____________ SOCIAL SECURITY # ______ _____________
NAME _________________________________ RELATIONSHIP ________________ DATE OF BIRTH _____________ SOCIAL SECURITY # ___________________
NAME _________________________________ RELATIONSHIP ________________ DATE OF BIRTH _____________ SOCIAL SECURITY # ______ _____________
Can anyone else possibly claim any of the dependents above? [ ] Yes (you will need to discuss this with your preparer [ ] No
Please list additional dependents on reverse.
Optional Information:
Are there any expected life changes anticipated in the next 12 months?
[ ] Purchase Home
[ ] Marriage
[ ] Divorce
[ ] Birth
[ ] Moving
[ ] Change in Job
[ ] Other: _____________________
ALSO PLEASE READ AND FILL OUT THE REVERSE SIDE OF THIS FORM
OFFICE USE ONLY:
TM _______________ QB_______________ PS _______________ O: _______________
UTF January 2015
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Parent category: Business