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*Taxpayer's Name (First, MI, Last):
*Taxpayer's Social Security Number: Example: 111-22-3333
*Taxpayer's Date of Birth: Example: 06/30/1970
Spouse's Name (First, MI, Last):
Spouse's Social Security Number: Example: 111-22-3333
Your URL (If applicable):
*email Address:
Home Phone: (10 Digits)Example: 321-555-1212
Work Phone: (10 Digits)Example: 407-555-1212
*Address 1:
Address 2:
*City/State/Zip+4:
County:
School District:
Information about Dependents
Dependent 1

First Name:

Last Name:

Relationship to you:

Social Security Number:

Date of Birth:

Months in your home in 2001:
Dependent 2

First Name:

Last Name:

Relationship to you:

Social Security Number:

Date of Birth:

Months in your home in 2001:
Dependent 3

First Name:

Last Name:

Relationship to you:

Social Security Number:

Date of Birth:

Months in your home in 2001:
Dependent 4

First Name:

Last Name:

Relationship to you:

Social Security Number:

Date of Birth:

Months in your home in 2001:
Dependent 5

First Name:

Last Name:

Relationship to you:

Social Security Number:

Date of Birth:

Months in your home in 2001:
If you have more than 5 dependents, list them in the additional information box at the bottom of this form.
Please Answer the Questions Below:
1 What is your filing status?
2 Did you buy or sell a home?
3 Do you own rental property?
4 Did you or your spouse pay any interest on a student loan?
5 Did you or your spouse pay any educational expenses for schooling beyond high school?
6 Did you or your spouse pay any childcare expenses?
7 Did you or your spouse make any IRA Contributions?
If YES, what type of IRA?
8 Did you make any estimated tax payments?
If YES, how much?
9 Did you or your spouse receive any social security benefits?
10 Did you or your spouse PAY or RECEIVE alimony?
11 Are you or your spouse self-employed (Own Business)
12 Do you have any moving expenses to deduct?
13 Did you or your spouse make any contributions?
14 Do you have any unreimbursed employee expenses?
15 Did you receive any letters from IRS last year?
16 Do you have a copy of your last year's tax return?
If YES, please bring it with you at the time of your appointment (that is, if you plan on coming in to the office, otherwise disregard this question).
The questions above are NOT all inclusive to prepare an accurate tax return.
They give our tax specialists an idea about the type of tax return they will need to prepare for you.
If you would like to give us any additional information at this time, which is NOT shown on your W-2's, 1098's, or 1099's, please enter it below.
*Click on the box when ready to send this form, then click Submit bar below: