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2016 Client Information Sheet

(please print)                                                                                                       

Your Name: ______________Occupation:____________Date of Birth ____/____/_____

Spouse’s Name: ___________Occupation:____________Date of Birth ____/____/_____

Home Phone Number (       ) _________________   Cell (       )________________________

Your e-mail: ______________________@_______________ 

Current Address:________________________________________________________________                          

_____________________________________________________________________________                                                       

(County)                                  (School District)                                            (Township/Municipality)

 

If you are a new client,

please provide us with your social security numbers: ____-___-___       ___-___-___

Did you change your address in the year 2016?  (         )YES 

   If  yes, what was the date you moved   ____/____/_________

 

Did your marital status change in the year 2016? (        )YES

-----------IF YES, did you change your name w/ Social Sec. Administration?

 New Name:_______________

 

Are you a dependent claimed by someone else?    (         )YES   (          )NO

 

Add/Remove DEPENDENTS ONLY – If claiming SAME as last year, just check here (      )       

(Do NOT write in spouse)

                                                    M/F     ADD      REMOVE                                  Did dependent live with me for more than ½ of the year 2016? 

Name: _____________[    ]   [    ]    [    ]  SSN: __ - __ - ___ DOB: ___/___/___    (    )YES   (    )NO

Name: _____________[    ]   [    ]    [    ] SSN: __ - __ - ___ DOB: ___/___/___    (    )YES   (    )NO

Name: _____________[    ]   [    ]    [    ] SSN: __ - __ - ___ DOB: ___/___/___    (    )YES    (    )NO

 

Child Care Expenses?   (         )YES   

  If yes, we need the Child Care Provider’s Social Security # or

       Federal EIN #:___________________

 

Education Tax Credits:   Did you pay for educational expenses

   for yourself, your spouse or a dependent in the year 2016? (      )YES

 

Homeowners & Tenants:  Did you make any energy efficient

   improvements in 2016?  (      )YES    If yes, please provide receipt.

"Marketplace" Health Insurance:  Please provide Form 1095 from Insurer.

                                   TP SP                                         TP SP                                    TP SP

Work Tools?$ ______ [  ] [  ]  Work Clothes?$ ______ [  ] [  ] Union Dues?$ ______ [  ] [  ]

 

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E-FILING SERVICES:  (Free with tax preparation) (mandatory)

TAX RETURN WITH REFUNDS

(     )  Please direct deposit my refund to my checking/savings/IRA account. 

          Please provide “VOIDED” check/proof of savings account numbers.  You may split the refund as you wish.

(     )  Please have my refund mailed to my home.

 

(     )YES  I WANT MY TAX RETURN PREPARATION FEES TAKEN OUT OF MY REFUND 

Extra Bank Fee Applies $35.00 (also deducted for you). 

Two forms of ID required –

 Current photo ID for Taxpayer and Spouse and  Social Security Card for ALL members of the Household.