Client Tax Information Sheet
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2Client Tax Information Sheet
JAMES E. WARREN, JR. & ASSOCIATES
11 Bruton Avenue
Did you have health insurance?
Newport News, VA 23601
E-FILE:
Yes
No
Yes
No
Phone 757-873-0032 ◊ Fax 757-873-4885
For DIRECT DEPOSIT of your refund(s) complete the information below or provide a Voided Check.
Checking
Savings
Routing Number:
Account Number:
*New Clients please provide a copy of last year’s Federal and State Tax Returns*
TAXPAYER NAME
SPOUSE’S NAME
DATE OF BIRTH
DATE OF BIRTH
SOC SEC NUMBER
SOC SEC NUMBER
OCCUPATION
OCCUPATION
STREET ADDRESS
TAXPYR WK PHONE
CITY/STATE/ZIP
SPOUSE WK PHONE
HOME PHONE
CELL PHONE(S)
TAXPAYER EMAIL
SPOUSE EMAIL
MARITAL STATUS
Single
Married
Separated
Divorced
DEPENDENT NAME
DATE OF BIRTH
DEPENDENT’S
RELATIONSHIP
(First, Middle Initial, Last)
SOC. SEC. NUMBER
** To claim a dependent 17 or over, they must be a fulltime student and provide 50% of support **
CHECK ALL INCOME SOURCES - PROVIDE DOCUMENTATION
Salary/Wages – W-2
Social Security/Railroad Retirement
Lottery/Gambling Winnings
Any 1099 income
Pension / Retirement Income
Interest / Dividends – 1099(s)
Alimony Received $ ____________
IRA Distributions
Farm Income
Unemployment $ ____________
K-1
Other Income (provide details)
Did You Sell Any Stocks/Bonds?
Did You Sell Real Estate?
Did You Refinance Any Property?
(Must provide
(Must provide 1099-B & cost basis)
Settlement statements, original purchase date/price)
(Must provide settlement statement)
Foreign Earned Income
(Must provide Contract Dates, Foreign Address and Travel Dates)
IRA Contributions
Taxpayer $_____________
Spouse $_____________
Traditional
Roth
Traditional
Roth
Quarterly Federal Estimated Tax Payments:
Job-Related Moving Expenses
$____________
st
rd
1
- _________________ 3
- __________________
Student Loan Interest Paid
$____________
nd
th
2
- _________________ 4
- __________________
Health Savings Account Paid
$____________
Quarterly State Estimated Tax Payments
Alimony Paid
$____________
st
rd
1
- _________________ 3
- __________________
Recipient’s Name:
________________________
nd
th
2
- _________________ 4
- __________________
Recipient’s SSN:
________________________
CHILD/DEPENDENT CARE EXPENSES
Dependent(s) Cared For
___________________________________
Care Provider’s Name
___________________________________
Provider’s SSN/EIN ______________
Provider’s Address
___________________________________
Amount Paid to Provider $_____________
____________
$
DEPENDENT CARE BENEFITS AMOUNT
(indicated on W-2 in box 10)
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