Application: Personal Tax Preparation
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3Date
Last Serviced
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For Office Use Only
Application: Personal Tax Preparation
Primary Taxpayer
-
-
__________________________
________________________
_____
___________
_________________
_____________
Last Name
First Name
M. I.
D.O.B.
SSN #
Occupation
Spouse
-
-
/
/
__________________________
________________________
_____
___________
_________________
_____________
Last Name
First Name
M. I.
D.O.B.
SSN #
Occupation
Address
Yes
No
________________________________________
_________________________
______
___________
_____________
Street Address
City
State
Zip
Own home?
Contact Information
(
)
-
(
)
-
__________________________
__________________________
____________________________________________
Cell Phone
Home / Business Phone
Email Address
(Circle One)
Filing Status
Driver's License - Primary
Driver's License - Spouse
Issue Date
Issue Date
Single
No.
No.
Married
State
State
Head of Household
Expiration
Expiration
Married Filing Separate
Banking
Information*
*
*
If banking information is left blank, your refund check will be mailed.
____________________________
____________________________
____________________________
Checking
Bank Name
Routing Number
Account Number
Savings
Dependent Information
Relationship
College Student?
Name
SSN #
D.O.B.
Yes
No
Yes
No
Yes
No
Yes
No
Dependent's College
Dependent's Childcare Provider
Provider Name
College Name
Address
College Name
EIN / SSN #
Phone
Mother's Maiden Name
Dependent Name
Primary
Amount Paid
Spouse
The purpose of this form is to gather information to be used to prepare your tax return. All information is implicitedly protected and will not be used except for that
purpose. Applicant, by the use of this form, gives Tax Depot Financial Services permission to transmit the tax return to the IRS and/or EPS Financial.
Phone: 770. 641. 8814
Fax: 770. 587. 4339
Email:
Signature ___________________________________________
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Parent category: Business