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Referred by
Tax Flier information
Best Phone No
*
Email
*
Your Full Name
*
Date of Birth
*
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Blind
*
yes
no
Your SSN
*
2020 ID Theft PIN (if you have one)
Did you receive EDD/Unemployment in 2020?
*
yes
no
Covered Ca / Obamacare (If yes, upload 1095-A form along with your other documents)
*
Yes
No
Spouse's name
Date of Birth
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Blind
yes
no
Over 65
yes
no
Spouse's SSN
Home Address
*
City
*
Zip Code
*
State
*
Do you rent ?
*
Yes
No
Your Job Title/Occupation
*
Spouse's Job Title/Occupation
Name of Dependent (1) Claimed as Exemption
Date of Birth
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Dependent (1) SSN
Relationship
Daughter
Son
Relative
Parent
Other
Name of Dependent (2) Claimed as Exemption
Date of Birth
+
Dependent (2) SSN
Relationship
Daughter
Son
Relative
Parent
Other
Name of Dependent (3) Claimed as Exemption
Date of Birth
+
Dependent (3) SSN
Relationship
Daughter
Son
Relative
Parent
Other
Child & Dependent Care Expenses
Name of Organization or Person who provided care
Phone No.
Address (street, city, state & zip code)
Tax ID/ EIN
Amount Paid
INCOME REPORTED
Type of income reported in 2020 (check all that apply)
*
Wages / Salary (W2)
Independent contractor (1099 MISC)
Self Employment / Bus. Income
Household employee
Unemployment (1099 G)
Early Retirement withdrawn (1099-R)
Social Security
Interest (1099 INT)
Dividends (1099 - DIV)
Gambling earnings (W2-G)
Disability
Rental Property income (including AIR BNB)
Sale of Real Estate
Alimony
Business Income (check all that apply)
Cash
Cash Apps (Paypal, Venmo, Zelle, etc.)
1099 - MISC
Corporate Filiers
1065 (Partnership)
1120 S (S-Corp)
1120 (C-Corp)
Self Employed LLC
Financial Statements (check all that apply)
Profit and Loss
Bank Statements
DEDUCTIONS
DEDUCTIONS CLAIMED (check all that apply) (will be discussed in further detail)
Medical Expenses (any and all)
Dental expenses (any and all)
Medical devices needed
Hospital
Nursing services
Long term care INS Prem
Travel expenses (mileage, parking, toll fees)
Taxes
State income Tax- Prior year refund
Real Estate Tax
Personal property Tax
Auto Registrations fees
Sales Tax on Auto Purchases
Mortgage Interest
1098 form
Refinance
Points paid (not on form 1098)
Investment interest
Charitable contributions
Church receipt or non-receipt)
Red Cross
Non-Profit
Emergency Relief Contributions
Goodwill
Salvation Army
Other
MISCELLANEOUS
Job related expense (any & all)
Auto expenses
Business meals and Entertainment
IRA contributions
Solar expenses
Legal/Professional expenses
Union dues
Other
Please state or list any other income, expenses, deductions or relevant information
TAX REFUND INFORMATION
Type of Refund Received
*
Green dot card (we will provide for free)
Money Card
Direct Deposit
Check (mailed)
Returning Clients Only: Are you using the same bank account from last year?
yes
no
If you chose for your refund to be direct deposited or you entering a new bank account and routing number, please enter below:
Bank Name
Routing No
Account No.
Authorization
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 ( Please Initial )
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Date
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You will receive an email with your PERSONAL SECURE CLIENT FOLDER, to upload your documents. Please RESPOND to this email from Fraztax (ID, SSN Cards, W-2s, 1099s, etc. )
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