Client Information:

*Last Name:

*First Name:

Middle Initial:

*Social Security Number:

*Occupation:

*Birth Date:

*Are you currently serving in the Armed Forces, or have you served within this past tax year?—Please choose an option—YesNo

If yes, please list your Home of Record:

Spouse Information:

Last Name:

First Name:

Middle Initial:

Social Security Number:

Occupation:

Birth Date:

Is your spouse currently serving in the Armed Forces, or has your spouse served within this past tax year?—Please choose an option—YesNo

If yes, please list your spouse's Home of Record:

Contact Information:

*E-Mail Address:

Second E-Mail Address:

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*Street Address:

Apartment/Suite/etc.:

*City:

*State:—Please choose an option—N/A - No StateAL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareFL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TennesseeTX - TexasUT - UtahVT - VermontVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - WyomingDistrict of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands

*ZIP Code:

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*Client's Home Phone:

Client's Work Phone:

Client's Cell Phone:

Spouse's Work Phone:

Spouse's Cell Phone:

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What is the best way to reach you?Home PhoneClient's Cell PhoneClient's Work PhoneSpouse's Cell PhoneSpouse's Work PhoneE-MailPostal Mail

Tax Related Questions:

#1*: Do you own the home you live in?—Please choose an option—YesNo

#2*: Did you buy or sell a home in the current tax year?—Please choose an option—YesNo

#3*: Did you sell, swap, trade, or exchange any stocks, bonds, mutual funds or unimproved property?—Please choose an option—YesNo

#4: If Yes to #3, do you know the purchasing price of these sales?—Please choose an option—YesNo

#5*: Did you pay someone to watch your children while you worked?—Please choose an option—YesNo

#6*: Did you make any payments on a student loan?—Please choose an option—YesNo

#7*: Did anyone in your family attend college or tech schools in the current tax year?—Please choose an option—YesNo

#8*: Do you or your spouse own your own business, and if so, what kind?—Please choose an option—YesNo

 

#9*: Do you have any rental property, and if so, what kind?—Please choose an option—YesNo

 

Please provide any additional information or comments: