Returning Client Form

 

Taxpayer Name(required)

Spouse Name

Phone Number(required)

Occupation(required)

Spouse Occupation

Address (Street/City/State/Zip)(required)

Email Address(required)

Dependents (Name/SSN/Birthdate/Relationship) - List All

Child & Dependent Care Expenses 2019? (Care Provider Name/Address-Street/City/State/ZIP/SSN or EIN/Amount Paid per Child) - List All

Got married or divorced or separated in 2019?

Brought a home in 2019?

Affordable Care Act Compliance(required) I had either employer-provided or privately purchased health care insurance for myself and my dependents for all of 2018.

I had Medicare/Medicaid or Tri-Care health care insurance for myself and my dependents for all of 2018.

I had health care insurance purchased/issued through the Federal and/or State Exchange for some or all of 2018 (provide 1095-A Health Insurance Marketplace Statement).

I did not have qualified health insurance for any or all of 2018 for myself and my dependents (additional information may be necessary to prepare your tax return).

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