Client Information Packet Important: *DL & SS Required Before Transmitting Return Note: If you currently have your maiden name on your Social Security card, please list the way your name appears on your card and PRESENT a copy of your Social Security Card for the file.Primary TaxpayerPrimary TaxpayerNameAddressAddressStateStateDaytime TelephoneCityZip CodeZip CodeCellYour email address (To let you know when your return has been accepted)Filing StatusSingle Head of Household (must have dependents and unmarried) Married Filing Jointly Married Filing Separately If you selected Married Filing Separately you do not qualify for electronic filing and the dependent care; EIC; hope and lifetime education credit; and adoption credit generally are not available.SpouseSpouseSpouse NameAddressAddressStateStateDaytime TelephoneCityZip CodeZip CodeCellEmail addressbreakDid you file with is last year?Yes No If no, how did you hear about us?Please, check the appropriate box if any of those apply to you. Please, include all supporting documentationSelf-employed W2 Wages from all jobs Itemize Deductions Cashed out a 401K Pay Child Support Received Interest Income Received Unemployment Dependent 1DependentsInfoAll children born before November 1, 2010 must have a social security numberDependent’s Full NameCollege Student?Yes No # of months they lived with youBirthdateRelationshipDependent 2Dependent 2Dependent’s Full Name College Student? Yes No # of months they lived with you Birthdate Relationship Dependent 3Dependent 3Dependent’s Full Name College Student? Yes No # of months they lived with you Birthdate Relationship Dependent 4Dependent 4Dependent’s Full Name College Student? Yes No # of months they lived with you Birthdate Relationship Dependent 5Dependent 5Dependent’s Full Name College Student? Yes No # of months they lived with you Birthdate Relationship EIC Eligibility Questionnaire (Required Completion by IRS)EIC Eligibility Questionnaire (Required Completion by IRS)If NOT, do you have permission either by the COURT or parent to claim the dependents?Yes No Will any of your Dependents be filing a tax return this year?Yes No Are you being claimed by someone else?Yes No CAN you PROVE EIC to the IRS if required to do so?Yes No Are the dependents being claimed as your LEGAL children?Yes No Where is/are the Parents?If yes, did the dependent claim themselves on that return?Yes No Were you disallowed the EITC last year?Yes No Mileage**If you are claiming MILEAGE and other job related expenses, you MUST present a copy of your COMPANY REIMBURSEMENT POLICY otherwise, all expenses will be DISALLOWED.**I AgreeAGREE THAT ALL INFORMATION PROVIDED TO A & B TAX SERVICE, LLC IS VALID AND KNOWLINGLY TO BE TRUE TO THE BEST OF MY ABILITY.Date:Security *Office Address:5600 Northwest Central Drive, Ste 241, Houston, TX 77095Address (281) 501-0809Phone: (281) 596-4474Fax: info@aandbtaxservice.comEmail: Send me a copy
