





PLEASE FILL OUT ALL THE APPLICABLE FIELDS
Taxpayer Name
Spouse Information
Dependent 1
Dependent 2
Dependent 3
Dependent 4
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
Bank Information
Self-employed
Business Expenses
Household Employee
Household Employee Definition: If you work for someone at their home and he/she controls what work is done, how you did the work; and, you made less than $3000 per household and you did not have to purchase any expenses, you are considered a household worker and not self-employed*Some examples of workers who do household work are: Babysitters, Caretaker, Cleaning People, Domestic Workers, Drivers, Health Aides, Housekeepers, Groundkeepers, Maids, Nannies, Private Nurses, Yard Workers, etc….If any person you worked for paid you $3000 or more for the entire year, you must provide the tax preparer with a W2, but if you worked for multiple people and they paid you less than $3000, please give us the total amount you were paid from each employer that year combined.
Ledger of Payment From
Employer/Employment Verification
IDME (IRS log in)
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