all years TAX Client Application

REFERRED BY:

+-

Filer; First Name *

Middle Initial

Last Name *

SSN or ITIN: *

DOB *

Street Address *

City *

State *

Zip Code *

Phone Number *

Are you a U.S. citizen? *

Filer Job Title for 2020 (Primary occupation/job) *

Email Address *

Can you be claimed as a dependent? *

Any government assistance or subsidized housing? *

If unmarried as of Dec. 31st, 2021. In order to qualify for Head of Household; Did you provide more than half the cost of keeping a home for you and your qualifying child/person? If so, select Yes and if not, select No. *

Select a Filing Status *

Tax year 2021 (last year) were you totally and permanently disabled: *

Tax year 2021 (last year) were you a Full Time/ Part-time student *

Tax year 2021 (last year) were you legally blind? *

Health Care? ( Obamacare / marketplace on Form 1095-A *

Filer: Do you have an Identity Theft Pin for the Tax Year 2019? If so, please list.

If you are not married, separated, divorced or a qualifying widow, skip spouse section

Spouse First Name and Middle Initial

Spouse Last Name

SSN or ITIN

DOB

Street Address (if different from spouse)

City

State

Zip Code

Spouse Phone Number

Is your spouse a U.S. citizen?

Spouse- can you be claimed as a dependent?

Spouse Job Title for 2019

Spouse Email Address

Spouse: Health Care? ( Obamacare / marketplace on Form 1095-A

Spouse: Tax year 2019 (last year) were you totally and permanently disabled:

Spouse: Tax year 2019 (last year) were you legally blind?

Spouse: Tax year 2019(last year) were you a Full Time/ Part-time student

Spouse: Do you have an Identity Theft Pin for the Tax Year 2019? If so, please list.

Please state any relevant information needed in regard to your filing status. i.e. separation, divorce decree. etc.

Number of dependents

1. Full Name of Dependent

Date of Birth

U.S. citizen?

SSN or ITIN

Relationship of Dependent

No. of Months lived in your home in 2019?

Student (college, university)

Was the dependent any of the following as of December 31, 2019; Check all that apply

2. Full Name of Dependent

Date of Birth

U.S. citizen?

SSN or ITIN

Relationship of Dependent

No. of Months lived in your home in 2019?

Student (college, university)

Was the dependent any of the following as of December 31, 2019; Check all that apply

3. Full Name of Dependent

Date of Birth

U.S. citizen?

SSN or ITIN

Relationship of Dependent

No. of Months lived in your home in 2019?

Student (college, university)

Was the dependent any of the following as of December 31, 2019; Check all that apply

List any other names not mentioned that lived with you or anyone else you supported in the tax year 2019 (last year); Please provide; Full name, SSN, DOB, Relationship, Single/Married, Student, Disabled.

2019 Total Income (estimated) *

Total Number of W-2s and/or other Income reporting Forms

Type of Income Reported in 2019 (check all that apply) *

Both Filers; If Self-employed, how did you report your expenses? Check all that apply

Profit and Loss Statement(s)

All profits received, but no related expenses significant to report

Haven't reported, but will need assistance

Do you own a home? Check all that apply.

Mortgage Interest Statement (Form 1098)

Property Taxes

Retirement Account

Education Expenses (check all that apply)

Total Student loan interest paid (form 1098e)

Total Alimony paid to: (list name/ssn)

Medical Expenses (check all that apply)

Total amount of Charitable Contributions

Childcare provider or paid babysitter: Name, Address, phone number, Tax ID or SSN and Total Amount Paid for 2019.

Any Balances due (IRS debts, State debts, child support, student loans in default, etc.) If so, estimated amount.

If you are due to receive a Refund. Type of deposit;

Wal Mart Debit Card

Direct Deposit

Check Mailed

Name of Bank or Financial Institution

Routing Number (9 digits)

Account Number

Account Number (repeat)

Driver Lic/ID Card

SSN Cards

All Wages and Income Forms (W2, 1099, 1099INT, 1099R, Cash Receipts, Bank Statements)

Mortgage Statement and Property Tax Bill

College Forms (1098T, Class Schedule, Financial Aid award letter.)

Other forms of not listed

Please list and discuss any other income, expenses, or things you are unsure about and need clarification:

PART II; INCOME AND EXPENSES AFTER WE RECEIVED YOUR APPLICATION WE WILL CONDUCT AN INTERVIEW FOR MORE DETAILS;

Please choose either the Standard or Itemized deduction (see tax table) *

If you select to itemized deductions please answer questions 1- 8

1. Medical and dental expenses

2. Real estate taxes

3. Personal property taxes

4. Mortgage Interest

5. Gift by cash or check

6. Employer reimbursement costs

7. 2019 yearly mileage

8. Total miles for work-related

If you are a household employee: (check all that apply) Then answer questions A and B.

A. Household employee yearly income earned in 2019

B. Expenses, if any

If you are an independent contractor or Self-employed complete the following:

How was your income received: (check all that apply)

Cash

Checks

Cash Apps (i.e Pay Pal)

Income reported on form 1099

Gross Receipts or Sales

Cost of goods sold

Advertising

Car and Truck expense (please select one of the following):

Car and Truck: "Actual Expenses" (skip if you selected the standard rate)

Total Business Miles driven (year)

Contract labor (did you hire anyone?)

Legal and professional expenses

Office expenses

Rent or lease

Supplies

Machinery and equipment rental fees

Tax and Licensing fees

Travel/ Meals / Entertainment

Utilities

List any other business expenses and total amounts for each

Consent to Disclose Tax Return Information to Frazier Accounting and Business Services. I/we hereby consent to the disclosure of tax return information described on this website to the terms above and allow the tax return preparer to enter a PIN in the tax preparation software on my behalf to verify that I/we consent to the terms of this disclosure. Please print your full name and date to affirm acceptance If you need further assistance please feel free to contact us at; 310.341.3990 *

Date *

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