Please complete so that we have your most current information on file (Upload to your portal or bring in). Do not email!
First Name / Last Name _______________________________________________________________
SS# / Date of Birth______________________________________________(DOD)_________________
Spouse First Name / Last Name ________________________________________________________
SS# / Date of Birth______________________________________________(DOD)_________________
Current mailing address:_______________________________________________________________
Apt #_________
City / State / Zip Code ____________________________________________________________
Cell Phone# for calls/texts:_________________________________________________________
Email address:_______________________________________________________________________
Did you pay for health insurance? Yes____(1095A) No____
Internet Virtual Currency (bitcoin) during _
tax year? Y____ N____
Students! Scholarship amount was used for fees, books or supplies $___________________
Scholarship amount included in
your W2 income $__________________
How did you hear about us? _______________________________________________________
Claiming Dependents? Yes ___ or No ___ If yes, are they SAME dependents as last year? Yes ___ No___
Dependents - EXACT spelling names, SS#, and Date of birth that is on file with SS Admin (803-772-1213)
Dependents name DOB & SS# Relationship #of Months Student or
First/Last in Home Disabled
_________________________________________ ___________________________________ ____________ _____ _____
_________________________________________ ___________________________________ ____________ _____ _____
_________________________________________ ___________________________________ ____________ _____ _____
_________________________________________ ___________________________________ ____________ _____ _____
Child Care Providers- 2441 Yes____ No____ (if yes, complete information
below or provide completed document from provider)
Provider name______________________________________________________________
Provider address____________________________________________________________
Tax ID # or SS# ____________________________________Amount Paid ______________
Indicate by ‘X’ if any of the following apply:
*Withdrawal from pension ____(1099-R) *Health insurance thru Marketplace_____(1095-A)
*HSA____(1099-SA) *Interest/Dividends_____ * Unemployment____(1099-G)
*Social Security benefits_____ *Retirement Contribution____ *Adoption____
*Energy Savings Purchases____ *Gambling winnings____(W2-G) *Virtual Currency_____
*Repayment of Homebuyer Credit____ *Student Loan Interest_____ *Alimony Paid or Received ____
*Student Education expenses_____(1098T) *Self-employed____(1099-NEC/Misc) *Business Owner____
*Rental property_____ Transportation Owner Operator _____ *Stock Trades____
Do you own a home? Yes ____ No____
Did you purchase or refinance a home during tax year (CD)? (Sch A) Yes ____ No ____
(If no, skip to question #1 below) (If yes, X or write in amount for all that apply)
*Last Year State Refund Received $______ *Medical, dental, optometry ______
*Property taxes paid_____ *Vehicle Taxes_____ *Land or other property taxes paid_____
*Mortgage Interest *Charitable (monetary_______; non-monetary_______) Refinance of New Home Purchase___
*Energy Savings Purchase______ *Repay $500 homebuyer credit______
Circle Yes or No:
1. Do you have all of that tax documents that were mailed to you? Yes___ No___
2. Do you have a copy of your previous year tax return with you? Yes___ No___
3. Did you live and work in one state for the entire year? Yes___ No___
4. Did you receive the Earned Income (EIC) last year? Yes___ No___
5. Is
there anyone else who can or will try to clan you or your dependents? Yes___ No___
6. Did you receive any income that you may have forgotten about? Yes___ No___
(i.e unemployment, short term jobs, etc)
8. Did you have any tax refund problems last year? Yes___ No___ If yes, describe______________________________________________________________________________________
9. Do you owe any prior year taxes, child support, unemployment...? Yes___ No___
If yes, or unsure call the IRS at 1-800-304-3107 (offsets), and 800-829-1954 (hotline) and let us know immediately.
10. How did you hear
about us?
Last year client___ Drive By/Office Sign____ Referred by__________________
Other? Please specify _________________________________________________________________