Primary Taxpayer

First Name *

Last Name *

Date of Birth *

Social Security Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Is this a new address? *

YES

NO

Phone Number *

Email Address *

Your Occupation *

*

Marital Status

Spouse Information (if applicable)

	For Married, Divorced, and Married but separated Only.
Last Name	For Married, Divorced, and Married but separated Only.
First Name	For Married, Divorced, and Married but separated Only.
Date of Birth	For Married, Divorced, and Married but separated Only.
Social Security Number	For Married, Divorced, and Married but separated Only.

Spouse Employed?

-Yes, if so submit supporting documents via Upload Docs

No

N/A

Dependent #1 is your

	Dependent Info
Last Name	Dependent Info
First Name	Dependent Info
Date of Birth	Dependent Info
Social Security Number	Dependent Info

Full-time student? K-12, COLLEGE, VOCATIONAL REHAB

Yes

No

Totally Disabled or Blind

Yes

No

Can anyone else claim this dependent? If Yes, Who?

No

Yes Yes

Lived with you how many months?

12 months

Or how many Or how many

Dependent #2 is your

	Dependent Info
Last Name	Dependent Info
First Name	Dependent Info
Date of Birth	Dependent Info
Social Security Number	Dependent Info

Full-time student? K-12, COLLEGE, VOCATIONAL REHAB

Yes

No

Totally Disabled or Blind

Yes

No

Can anyone else claim this dependent? If Yes, Who?

No

Yes Yes

Lived with you how many months?

12 months

Or how many Or how many

Dependent #3 is your

	Dependent Info
Last Name	Dependent Info
First Name	Dependent Info
Date of Birth	Dependent Info
Social Security Number	Dependent Info

Full-time student? K-12, COLLEGE, VOCATIONAL REHAB

Yes

No

Totally Disabled or Blind

Yes

No

Can anyone else claim this dependent? If Yes, Who?

No

Yes Yes

Lived with you how many months?

12 months

Or how many Or how many

Select all that apply

Upload Identification i.e. State ID, Driver's License, Passport, Military ID **UPLOAD TAXPAYER IDENTIFICATION ONLY DO NOT INCLUDE SOCIAL SECURITY CARDS IN THIS SECTION** *

Spouse Identification ***ONLY Needed if filing MARRIED FILING JOINTLY***