First Name *

Last Name *

Phone *

Email *

How did you hear about us?

Were you reffered by anyone?

Captcha *

Taxpayer Details

Address *

City *

State *

Postal code *

Date of birth *

Social Security Number *

State and Driver's License ID # *

Issue Date *

Expiration Date *

Document Number (NY Only) *

Taxpayer Employment

Job Title / Occupation *

Who is your employer? *

Work Phone *

Spouse Details

Spouse Full Name

Spouse Date of Birth

Spouse Social Security Number

Spouse State & Driver's License ID #

Spouse Issue Date

Spouse Expiration Date

Spouse Document Number

Tax Information

You tax-filing status? *

Single

Married Filing Joint

Married Filing Separate

Head of Household

Qualifying Widower

List the state you lived in during the tax year.

Resident State *

List any state where you had your taxes withheld, but were not a resident.

Non-Resident State

Tax Details

Did you live at the address given for 6 months or more this year? *

Yes

Did you file your taxes last year? *

Yes

If yes, did you receive a refund? *

Yes

How did you file your taxes last year? *

W-2

1099

Small Business

Corporation

Can you get a copy of your prior year's tax return if needed? *

Yes

Were you previously disallowed the Earned Income Credit?

Do you need to file IRS form 8862? *

Yes

Did you have health insurance during the tax year? *

Yes

Dependent Tax Information

Did your dependents have health insurance through either your employer, state, or obamacare?

Yes

If yes, which dependents?

Dependent #1

Dependent #2

Dependent #3

All Dependents

Dependent #1 Details

Dependent #1 Full Name

Dependent #1 Date of Birth

Dependent #1 Social Security Number

Dependent #1 Relationship To You

Please select

Son
Daughter
Step Child
Eligible Foster Child
Brother
Sister
Half Brother
Half Sister
Step Brother
Step Sister
Adopted Child
Mother
Father
Grandmother
Grandfather
Qualified Relative
No elements found. Consider changing the search query.
List is empty.

Dependent #2 Details

Dependent #2 Full Name

Dependent #2 Date of Birth

Dependent #2 Social Security Number

Dependent #2 Relationship To You

Please select

Son
Daughter
Step Child
Eligible Foster Child
Brother
Sister
Half Brother
Half Sister
Step Brother
Step Sister
Adopted Child
Mother
Father
Grandmother
Grandfather
Qualified Relative
No elements found. Consider changing the search query.
List is empty.

Dependent #3 Details

Dependent #3 Full Name

Dependent #3 Date of Birth

Dependent #3 Social Security Number

Dependent #3 Relationship To You

Please select

Son
Daughter
Step Child
Eligible Foster Child
Brother
Sister
Half Brother
Half Sister
Step Brother
Step Sister
Adopted Child
Mother
Father
Grandmother
Grandfather
Qualified Relative
No elements found. Consider changing the search query.
List is empty.

Earned Income Credit - Qualification Details

The IRS continues to intensify its efforts to verify Earned Income Tax Credit (EIC) claims as well as the child tax credits, education credits and returns claiming head of household status. The IRS is holding tax preparers responsible for exercising “DUE DILIGENCE” in preparing such tax returns. Failure to make sufficient inquiries subjects a tax preparer to fines and penalties of $530 PER ERROR, PER RETURN. Therefore, the following information is NEEDED from you in order to claim the Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, Other Dependent Credit, and/or Head of Household filing status. THIS INFORMATION IS REQUIRED, NO EXCEPTIONS.

Other Dependents

Due Diligence Questionnaire for returns with Earned Income Tax Credit, Child Tax Credit, Other Dependent Credit or Head of Household filing status. In the following text-box, please input your dependent names and relationship to you.
For Example:
John Doe - Son
Jane Doe - Daughter
Mary Doe - Mother

Household Member Name(s) and Relationship to the Taxpayer *

Did all of your dependents live with you for at least 6 months?

Yes

Did you file these same dependents last year?

Yes

Will any of your dependents be filed with someone else?

Yes

Did the child or adult dependent receive any income last year, including but not limited to scholarships or grants, student loans, wages, child support, alimony, public assistance, Social Security or disability benefits?

Child Care Provider Details (if any)

Child Care Provider Full Name

Child Care Provider Street Address

Child Care Provider Apartment, Suite, Unit

Child Care Provider City

Child Care Provider State

Child Care Provider Zip Code

Child Care Provider Tax ID Number

Total Payment for Child Care Services

Taxpayer Tax Details

How many jobs did you work during the tax year? *

3 or more

Did you receive any unemployment income? *

Yes

Did you attend college, night school, internet schooling, or any post-secondary educational facility to gain a skill or degree? *

Yes

Do you have a 1098-T from your school? *

Yes

Are you currently paying or owe any student loans? *

Yes

Do you own your home? *

Yes

Do you owe for home buyers credit? *

Yes

Do you lease out any of the property you own? *

Yes

Did you pay any church tithes or other large charitable contributions? *

Yes

Do you owe back-payments for child support? *

Yes

Do you owe the IRS? *

Yes

Tax Refund Details

How would you like your Federal and State Tax Refund Check issued? *

Check by Mail

Direct Deposit

Are you interested in using your refund to pay for your tax prep services? Fees apply.

Yes

Name of Bank

Bank Routing Number

Bank Account Number

Terms and Conditions

BY CLICKING THE CHECKBOX BELOW, YOU HEREBY AGREE THAT THE FOREGOING INFORMATION IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE AND RECOLLECTION. YOU ALSO AGREE THAT YOU HOLD NO BEARINGS UPON PREPARERS OR COMPANY STAFF. YOU ALSO AGREE TO THE TERMS AND CONDITIONS OF SERVICES SET FORTH. *

Terms and Conditions *

I agree to the terms and conditions set forth by my tax professional for the provided tax preparation services.

BY CLICKING THE CHECKBOX BELOW AND FILLING OUT MY FULL NAME AND DATE BELOW, I AM PROVIDING MY WRITTEN CONSENT AND SIGNATURE AUTHORIZATION THAT I HEREBY AGREE THAT MY ELECTRONIC SIGNATURE HOLDS VALID IN THE COURT OF LAW AND AGREE TO ALL THE TERMS AND CONDITIONS SET FORTH. *

Electronic Signature Authorization *

I consent that my written name and electronic signature is truly signed by me, the signatory, and that my signature holds legal and valid for any applicable courts.

Thank you for taking the time to fill out our virtual interview. Please give it two to three minutes after you click submit to successfully send over all of your information. You will get a thank you confirmation message after a successful submit. Please do not close the browser tab until then.

Full Name *

Signature *

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