New Client FormBy wagnertax / January 21, 2016 New Client Personal Taxes Already Have An Appt Set With Us? * Yes No If Yes Please Type Your Appt Date In This Format mm/dd/yy Who Referred You / How Did You Hear About Wagner Tax * Please tell us who referred your or how You heard about us. FILING STATUS Choose your filing status for the current tax year being filed. FILING STATUS (PLEASE ONLY MARK ONE): * SINGLE MARRIED FILING JOINT MARRIED FILING SEPARATE HEAD OF HOUSEHOLD QUALIFYING WIDOW(ER) The Head of Household Status is for single parents or single qualified relatives raising child dependents alone. If a divorce was not final by 12/31 of the tax year being filed, you must not have lived in the same home as the separated spouse at any time during the last 6 months of the tax year. TAXPAYER INFORMATION PRIMARY TAXPAYERS NAME * (FIRST,MIDDLE INITIAL,LAST) SOCIAL SECURITY NUMBER * OCCUPATION * (current occupation. If unemployed or retired please indicate so. Date Of Birth * Must Match IRS Date Of Death SPOUSE INFORMATION SPOUSES NAME (FIRST,MIDDLE INITIAL,LAST) OCCUPATION (current occupation. If unemployed or retired please indicate so. SOCIAL SECURITY NUMBER Date Of Birth Must Match IRS Date Of Death TAXPAYER'S CONTACT INFORMATION STREET ADDRESS * This address will be used for government correspondence and will be listed as your tax returns mailing address. CITY * STATE * ZIP CODE * HOME PHONE NUMBER If no home please list primary cell phone number PRIMARY TAXPAYERS CELL * SPOUSES CELL PRIMARY TAXPAYERS EMAIL ADDRESS * SPOUSE EMAIL ADDRESS Child & Dependent Information #1 DEPENDENT #1: NAME Full Name as it appears on Social Security Card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. DATE OF DEATH SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #2 DEPENDENT #2: NAME Full Name as it appears on Social Security Card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. DATE OF DEATH SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #3 DEPENDENT #3: NAME Full Name as it appears on Social Security Card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. DATE OF DEATH The date of birth must match what is on file under the dependents social security card. SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #4 DEPENDENT #4: NAME Full Name as it appears on Social Security Card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. DATE OF DEATH SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. Child & Dependent Information #5 DEPENDENT #5: NAME Full Name as it appears on Social Security Card. SUFFIX If the child / dependent uses a suffix such as Jr. or Sr. and it is used on thier social security card please list here. DATE OF BIRTH The date of birth must match what is on file under the dependents social security card. DATE OF DEATH SOCIAL SECURITY NUMBER RELATIONSHIP TO TAXPAYER (Son, daughter, parent, grandchild, brother, sister, other, niece, nephew, father, mother ect.) HOW MANY MONTHS DID YOUR DEPENDENT LIVE WITH YOU THIS CALENDAR YEAR? Please type only the number of months the dependent lived with you during the year. College students under 25 going to school away from home qualify as if they were living with you all 12 months for tax dependent purposes. E-FILE TAX REFUND | DIRECT DEPOSIT BANKING INFORMATION. If you end up with a Refund on your taxes and you would like to submit your banking info for direct deposit by the US Treasury Use The Following Secure Link To Provide That Data. Secure Direct Deposit Form (We Use Bank Level SSL Protection) Send Us Copies Of Your Previous Tax Returns or Current Tax Docs Drop a file here or click to upload Choose File Maximum file size: 104.86MB If you are human, leave this field blank.
