Income Tax Data Form

Gather everything a preparer needs before a return is filed: identification, dependants, income categories, deductions and the filing option chosen. Clients confirm childcare provider details and authorise the fee to be taken from a refund. Signatures from both spouses close the submission.

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Preparer ID

Tax Year

Please choose which returns you want to file

Federal return State return Amended return Extension request Business return

Name

Nombre

Apellido

Date of Birth

Driver's License #

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Can someone else claim you as a dependent?

Yes No Not known

Name of Dependent

Nombre

Apellido

Date of Birth

Name of Dependent

Nombre

Apellido

Date of Birth

Name of Dependent

Nombre

Apellido

Date of Birth

Wages or Salary (W2 Income)

I have W2 forms I had multiple employers Documents already attached Not applicable

Interest Income 1099-INT

Bank interest Bond interest Documents already attached Not applicable

IRA accounts

Traditional IRA Roth IRA Rollover None

Charitable or religious contributions

Cash donations Non-cash donations Contributions to a congregation None

Provider Name

Nombre

Apellido

Provider Phone Number

Provider Address

Dirección

Ciudad

Estado / Provincia

Código postal

Paper filing (fee paid upfront)

Select this option I need more information Not applicable

Electronic filing (fee paid upfront)

Select this option I need more information Not applicable

Flex-pay from your refund (ask the preparer for details)

Select this option I need more information Not applicable

Bank products

Direct deposit Refund transfer Prepaid card None

May our financial advising department contact you about the concerns you indicated above?

Yes No Yes, but later

Client Signature

Sign here

Date

Spouse Signature

Sign here

Date

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