Tax Return With Dependents

Filing Status:
Place status here

Client Status *

Today's Date *

* Field is Required
Dates: MM/DD/YYYY

Taxpayer Information:

Date of Birth (mm/dd/YYYY) *

Your Occupation *

Date Retired *

Choose Any That Apply *

Can be claimed on another return Full time student Legally blind Permanent & totally disabled

Taxpayer Identity Verification:

Please provide a valid photo ID :

You can email a copy,
Drop off a copy, or
Bring it to the office and we will copy it.

Please DO NOT text any tax documents.

Taxpayer IRS Identity PIN:

Did the IRS issue you an Identity PIN *

Identity PIN *

Spouse Information:

Date of Birth (mm/dd/YYYY) *

Spouse Occupation *

Date Retired *

Choose Any *

Can be claimed on another return Full time student Legally blind Permanent & totally Disabled

Spouse Identity Verification:

Address:

Number & Street *

Apartment Nbr. *

City *

State *

ZIP *

Multi-State Residency:

Complete this section ONLY if your LIVED in
a State other than South Carolina last Year.

State of Residency on Dec 31st *

County *

City or Municipality *

School district *

Date taxpayer moved *

Date spouce moved *

Multi-State?
Please provide any City, County, and/or Municipality tax forms required to file in another State.

Forms Needed? *

Taxpayer *

Affordable Care Act (Obama Care) Other or none

Spouse *

Affordable Care Act (Obama Care) Other or none

Choose One *

Direct deposit Check mailed

NOTE: If your refund is a direct deposit bring a voided check to the office.

Complete this section if you are claiming a dependent and/or qualifying person.

The IRS will check the information submitted for this dependent against the information they received from the Social Security Administration (SSA). If the information submitted is inconsistent with the SSA file or if this dependent has been claimed on any other return, the IRS may either reject the dependent or the entire return.

If qualifying for Earned Income Tax Credit, Child Tax Credit,
Other Dependent Credit or Head Of Household.
The IRS requires you provide the following documents
(Bring these documents to the tax office)

Dependents birth certificates
Dependents Social Security Cards
Proof of residence document with dependent’s name and your address.
- Such as a school record, medical record, etc.

First Dependent

Name - First Dependent *

First

Last

SSN (###-##-####) *

DOB (MM-DD-YY) *

Relationship to you? *

Dependent type *

Citizenship *

Number of months lived with you in the US? *

Number of months lived with you outside the US? *

Dependent permanently Disabled last year? *

Yes No

Are you divorced or separated and claiming this dependent? *

Yes No

Was this child a full-time student last year? *

Yes No

Enter the total day care expenses for this person. *

If this person died last year enter Date of Death. *

IRS issued Identity PIN. *

Name - Second Dependent *

First

Last

SSN (###-##-####) *

DOB (MM-DD-YY) *

Relationship to you? *

Dependent type *

Citizenship *

# Months lived with you in the US? *

# Months lived with you outside the US? *

Dependent permanently Disabled last year? *

Yes No

Are you divorced or separated and claiming this dependent? *

Yes No

Was this child a full-time student last year? *

Yes No

Enter the total day care expenses for this person. *

If this person died last year enter Date of Death. *

IRS issued Identity PIN. *

Name - Third Dependent *

First

Last

SSN (###-##-####) *

DOB (MM-DD-YY) *

Relationship to you? *

Dependent type *

Citizenship *

# Months lived with you in the US? *

# Mmonths lived with you outside the US? *

Dependent permanently Disabled last year? *

Yes No

Are you divorced or separated and claiming this dependent? *

Yes No

Was this child a full-time student last year? *

Yes No

Enter the total day care expenses for this person. *

If this person died last year enter Date of Death. *

IRS issued Identity PIN. *

Describe additional tax requirements / concerns. *

Choose One *

Gary Bill Gary or Bill

Filing Status:
Place status here

Taxpayer Information:

Taxpayer Identity Verification:

Taxpayer IRS Identity PIN:

Spouse Information:

Spouse Identity Verification:

Address:

Multi-State Residency:

Health Insurance Provider:

Refund Method:

NOTE: If your refund is a direct deposit bring a voided check to the office.

Complete this section if you are claiming a dependent and/or qualifying person.

First Dependent

Additional information:

Type of return:

Preferred preparer:

Filing Status:Place status here

Taxpayer Information:

Taxpayer Identity Verification:

Taxpayer IRS Identity PIN:

Spouse Information:

Spouse Identity Verification:

Address:

Multi-State Residency:

Health Insurance Provider:

Refund Method:

NOTE: If your refund is a direct deposit bring a voided check to the office.

Complete this section if you are claiming a dependent and/or qualifying person.

First Dependent

Additional information:

Type of return:

Preferred preparer:

Filing Status:
Place status here