SECTION 1: TAXPAYER INFORMATION A. Personal Information First Name Middle Name Last Name SSN Upload SSN Verification Date of Birth Driver's License/State ID State License Number Upload Driver’s License/ID Issue Date Expiration Date Contact Information Primary Phone Secondary Phone Email Preferred Contact Method PhoneEmailText Current Address Street City State ZIP County Date Moved to Address Occupation Employer Upload Employer Verification B. Filing Status Select One [radio* filing-status "Single" "Married Filing Jointly" "Married Filing Separately" "Head of Household" "Qualifying Widow(er)"] Did your filing status change from last year? YesNo If yes, explain: C. Spouse Information (if applicable) First Name Middle Name Last Name SSN Upload Spouse SSN Verification Date of Birth Spouse Driver's License/State ID State License Number Upload Spouse Driver’s License/ID Issue Date Expiration Date Spouse Contact Information (if different) Phone Email Occupation Employer Upload Spouse Employer Verification Previous Next SECTION 2: DEPENDENT INFORMATION A. Dependent #1 Name SSN Upload SSN Verification Date of Birth Relationship Months Lived with You Full-time Student Yes Disabled Yes Childcare Expenses Upload Childcare Expense Documentation Education Expenses Upload Education Expense Receipts or Statements Medical Expenses Upload Medical Expense Documentation Previous Next SECTION 3: INCOME INFORMATION A. W-2 Employment Income Employer Name EIN Wages (Box 1) Federal Tax Withheld (Box 2) Upload W-2 Form Social Security Wages (Box 3) Medicare Wages (Box 5) Additional W-2s? Yes B. Other Income Sources Interest Income (1099-INT)? Yes Amount Institution Upload 1099-INT Form Dividend Income (1099-DIV)? Yes Qualified Dividends Ordinary Dividends Upload 1099-DIV Form Stock Sales (1099-B)? Yes Total Proceeds Total Cost Basis Upload 1099-B Form Previous Next SECTION 4: DEDUCTIONS A. Housing Information Home Status [radio* home-status "Own" "Rent"] Mortgage Interest (1098) Upload the 1098 form Property Taxes Receipts or statements showing property tax payments PMI Premiums Home Insurance Home Energy Improvements? Yes If yes, Type: Cost Date Installed B. Medical Expenses Healthcare Premiums Upload receipts or statements for any major expenses Out-of-pocket Medical Dental Expenses Vision Expenses Medical Mileage (in miles): C. Retirement Contributions 401(k) Contributions IRA Contributions HSA/FSA Contributions: D. Education Expenses Student Loan Interest Upload tuition bills or payment statements Tuition and Fees Books and Materials Educational Equipment E. Job-Related Expenses Work Uniforms Professional Dues Licensing Fees Required Equipment Job Search Costs: F. Vehicle Information Vehicle Used for Work? Yes If yes, Make/Model: Year Date Placed in Service Total Miles Business Miles Commuting Miles Previous Next SECTION 5: CREDITS A. Child and Dependent Care Care Provider Name Tax ID Receipts or statements for childcare expenses Amount Paid: B. Education Credits Student Name Institution Year in College Form 1098-T Amount Upload forms such as 1098-T for education credits C. Energy Credits Solar Panels Electric Vehicle Energy-Efficient Improvements Previous Next SECTION 6: BANKING INFORMATION Direct Deposit Information: Bank Name Routing Number Account Number Type CheckingSavings Previous Next SECTION 7: DOCUMENTATION CHECKLIST Required Documents: All W-2 Forms 1099-INT/DIV Forms 1098 Mortgage Statement Property Tax Statement Charitable Donation Receipts Medical Expense Records Child Care Records Education Expense Records Prior Two Years Tax Return Previous Next SECTION 8: SIGNATURES I declare that the information provided is true, correct, and complete. Taxpayer Signature Date Spouse Signature Date Previous Next
