TAXWORKS PRO

CLIENT DATA FORM

This form is to assist you in gathering your Income Tax Information.

PRIMARY NAME

PRIMARY SSN

PRIMARY DATE OF BIRTH

YYYY

SPOUSE NAME (if applicable)

SPOUSE SSN

SPOUSE DATE OF BIRTH

YYYY

PHONE

EMAIL ADDRESS

HOME ADDRESS

***PLEASE COMPLETE THIS SECTION IF YOU HAVE DEPENDENTS***

DEPENDENT #1 NAME

RELATIONSHIP

DEPENDENT #1 SSN

DEPENDENT #1 DATE OF BIRTH

YYYY

MONTHS LIVED IN YOUR HOME

DEPENDENT #2 NAME

RELATIONSHIP

DEPENDENT #2 SSN

DEPENDENT #2 DATE OF BIRTH

YYYY

MONTHS LIVED IN YOUR HOME

DEPENDENT #3 NAME

RELATIONSHIP

DEPENDENT #3 SSN

DEPENDENT #3 DATE OF BIRTH

YYYY

MONTHS LIVED IN YOUR HOME

Please Check the Box(es) if any of the Following Apply to You for the Current Tax Year:

I Purchased Health Insurance through the Healthcare Marketplace

Someone Can Claim Me as A Dependent

Paid College Tuition and Expenses

Paid Estimated Federal and/or State Taxes

Traditional IRA Contribution

Paid Student Loan Interest

Paid Childcare or Dependent Care

Itemize