New Client Information Worksheet
Enter all the information which you currently have available. If you have any information not covered on this worksheet please enter it in the Additional Tax Information or Suggestion Box.
TAXPAYER
SPOUSE
LAST NAME
Last Name
LAST NAME
MIDDLE INITIAL
MIDDLE INITIAL
FIRST NAME
First Name
FIRST NAME
SOCIAL SECURITY
SOCIAL SECURITY
DATE OF BIRTH
Date of Birth
DATE OF BIRTH
DATE OF DEATH
DATE OF DEATH
OCCUPATION
Occupation
OCCUPATION
WORK NUMBER
WORK NUMBER
CELL PHONE NUMBER
Cell Number
CELL PHONE NUMBER
E-MAIL ADDRESS
EMail
E-MAIL ADDRESS
DRIVER'S LICENSE/STATE ID
EMAIL Format
DRIVER'S LICENSE/STATE ID
LICENSE NUMBER
License Number
LICENSE NUMBER
ISSUING STATE
ISSUING STATE
ISSUE DATE
Issue Date
ISSUE DATE
EXPIRATION DATE
Expire Date
EXPIRATION DATE
LEGALLY BLIND
No
Yes
LEGALLY BLIND
No
Yes
ADDRESS
Address
CITY
City
STATE
State
ZIP CODE
Zip Code
FEDERAL FILING STATUS
Please Choose A Filing Status
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow (er)
DEPENDANT INFORMATION
FIRST NAME
MI
LAST NAME
DATE OF BIRTH
DEPENDANT SOCIAL SECURITY NUMBER
RELATIONSHIP
NO MONTHS LIVED
CHILD CARE PAID
None
Son
Daughter
Fosterchild
Stepchild
Fosterchild
Grandchild
Parent
Mother
Father
Grandparent
Aunt
Uncle
Niece
Nephew
Sister
Brother
0
1
2
3
4
5
6
7
8
9
10
11
12
None
Son
Daughter
Fosterchild
Stepchild
Fosterchild
Grandchild
Parent
Mother
Father
Grandparent
Aunt
Uncle
Niece
Nephew
Sister
Brother
0
1
2
3
4
5
6
7
8
9
10
11
12
None
Son
Daughter
Fosterchild
Stepchild
Fosterchild
Grandchild
Parent
Mother
Father
Grandparent
Aunt
Uncle
Niece
Nephew
Sister
Brother
0
1
2
3
4
5
6
7
8
9
10
11
12
None
Son
Daughter
Fosterchild
Stepchild
Fosterchild
Grandchild
Parent
Mother
Father
Grandparent
Aunt
Uncle
Niece
Nephew
Sister
Brother
0
1
2
3
4
5
6
7
8
9
10
11
12
None
Son
Daughter
Fosterchild
Stepchild
Fosterchild
Grandchild
Parent
Mother
Father
Grandparent
Aunt
Uncle
Niece
Nephew
Sister
Brother
0
1
2
3
4
5
6
7
8
9
10
11
12
CHILD DEPENDANT CARE INFORMATION
NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
FEDERAL EIN OR SOCIAL SECURITY NUMBER
AMOUNT PAID
EDUCATION TUITION & FEES ON 1098 FORM
SCHOOL NAME
EMPLOYER IDENTIFICATION NUMBER
ADDRESS
CITY
STATE
ZIP CODE
BOX 1 PAYMENTS RECEIVED
BOX 4 ADJUSTMENTS MADE PRIOR YEAR
BOX 5
SCHOLARSHIP GRANTS
SCHEDULE A INFORMATION
REAL ESTATE/PROPERTY TAXES
PERSONAL PROPERTY TAXES
MORTGAGE INTERESTS 1098 FORM
MORTGAGE INTEREST NO FORM
CASH CONTRIBUTIONS (Church, Ect.)
NON CASH CONTRIBUTIONS
DATE OF CONTRIBUTION
NAME OF CHARITY
STREET ADDRESS
CITY
STATE
ZIP CODE
VALUE OF DONATION
DESCRIPTION OF DONATION
UNREIMBURSED EMPLOYEE EXPENSES
INCOME TAX PREPARATION FEE
UNION DUES
EDUCATOR EXPENSES
JOB SEARCH COSTS
PROFESSIONAL SUBSCRIPTIONS
JOB PARKING FEES
BUSINESS GIFTS
UNIFORMS/PROCTIVE CLOTHING
JOB TRAVEL EXPENSES
DIRECT DEPOSIT INFORMATION
NAME OF FINANCIAL INSTITUION
ROUTING / TRANSIT NUMBER
ACCOUNT NUMBER
Checking
Savings
Other
ADD ANY ADDITIONAL INFORMATION OR SUGGESTIONS
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