tax filing year *

Select Tax Preparer *

Please provide the name of the person who referred you or provide the place where you saw our business

If you're filing married separately, how many months out of the year were you living apart from spouse?

If you are filing head of household, are you unmarried? *

yes

no

Do you or your dependents have an IP PIN? *

yes

no

Do you have marketplace insurance? *

yes

no

Did you get a refund last year? If so upload transcript or copy of tax return (New Clients Only) *

yes

no

transcript or tax return

Are you interested in credit repair *

yes

no

Full Name

First Name *

Last Name *

Phone *

(area code)-xxx-xxxx

Email *

[email protected]

Tax Payers Social Security Number *

xxx-xx-xxxx

Tax Payer Date of Birth *

Address

Street Address *

City *

State *

Country

Postal Code *

Did you receive health insurance through the marketplace? *

yes

no

Your Occupation *

If so, please provide the following 1. States you worked in 2. Timeframe you worked in those states

Have you ever been audited by the IRS? *

yes

no

If so, Please provide the year/s of audit and what were the outcomes of the audits

Primary Taxpayer - Please Check Any That Apply

Taxpayer can be claimed as a dependent on someone else's return.

Taxpayer was over age 18 and a full-time student at an eligible educational institution.

Taxpayer is blind.

Taxpayer is deceased.

Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Taxpayer prefers to receive written communications from the IRS in a language other than English.

Taxpayer prefers to receive written communications from the IRS in an accessible format.

Taxpayer is disabled.

Spouse Information

If no spouse, please skip

Spouse Full Name

First and Last Name

Spouse Date Of Birth

Spouse's Social Security Number

Spouse Occupation

Spouse Email Address

[email protected]

Spouse - Please Check Any That Apply

Spouse can be claimed as a dependent on someone else's return.

Spouse was over age 18 and a full-time student at an eligible educational institution.

Spouse is deceased.

Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.

Spouse prefers to receive written communications from the IRS in a language other than English.

Spouse prefers to receive written communications from the IRS in an accessible format.

Spouse is disabled.

Dependent Information

The Earned Income Credit (EIC) increases with the first 3 Children you claim. The maximum number of dependents you can claim for Earned Income Purposes is Three. You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPARATE you CAN'T claim the credit.

Do you have dependents to claim on your taxes? *

First Dependent (First and Last Name) *

Date of Birth *

yyyy-dd-mm

Dependent Age

social security number *

Are they a full-time student? *

Yes

No

Disabled? *

yes

no

How many months did the child live in your home? *

minimum 1 Maximum 12

relationship to you? *

son, daughter, niece, nephew etc.

If the dependent is age 17 or older, please indicate if they are married. *

yes

no

(2)Do you have another dependent to add?

Second Dependent (First and Last Name)

Date of Birth dependent ?

yyyy-dd-mm

How old is dependent ?

Social Security Number

Full time student?

yes

no

Disabled?

yes

no

How many months did the child live in your home?

relationship to you?

son, daughter, nephew, niece etc.

If the dependent is 17 or older, is that dependent married?

yes

no

(3)Do you have another dependent to add?

Third Dependent (First and Last Name)

Date Of Birth of dependent

yyyy-dd-mm

How old is dependent?

social security number

Full time student ?

yes

no

disabled?

yes

no

How many months did the child live in your home?

relationship to you?

son, daughter, nephew, niece etc.

If the dependent is age 17 or older, please indicate if they are married.

yes

no

(4)Do you have another dependent to add?

Fourth Dependent (First and Last Name)

Date of Birth

yyyy-dd-mm

How old is the dependent ?

Social Security Number

Full time student ?

yes

no

Disabled ?

yes

no

How many months did the child live your home

Relationship to you?

son, daughter, nephew, niece etc.

If the dependent is age 17 or older, please indicate if they are married.

yes

no

(5) Do you have another dependent to add?

Fifth Dependent (First and Last Name)

Date of Birth

yyyy-dd-mm

How old is the dependent ?

Social Security Number

Full time student?

yes

no

Disabled?

yes

no

How many months did the child live your home?

Relationship to you?

son, daughter, nephew, niece etc.

If the dependent is 17 or older, is that dependent married?

yes

no

Does your child/children have the same last name as you? *

yes

no

If not, is it the last name of the child/children father? *

yes

no

Taxpayer IP PIN (Issued from IRS yearly) EVERYONE DOESN'T HAVE THIS. IF IT DOESN'T APPLY SKIP.

Business Information

Please complete if you are self employed.

Are you self employed or a business owner? *

yes

no

Business Address

Enter Full Address

If so what kind of business do you have?

Please provide your business EIN Number

How Long Have you been in Business?

Please upload your profit/expense records.

Did you have a vehicle you used for your business?

yes

no

If so, list the year make and model of the vehicle

Do you have a seperate personal vehicle?

yes

no

College Student Information

Please complete if anyone in your household went to college

Did anyone listed on this return attend college this tax season *

yes

no

If so-please upload from 1098-T and other college related documents below

Name(s) of the person who attended college

Did all students attend at least half time?

yes

no

Were they seeking a degree?

yes

no

How much money was spent on tuition or other required course materials?

How many tax years have you claimed the American Opportunity Tax Credit?

was the student ever charged with drug related felonies?

yes

no

Are you currently paying student loans?

yes

no

If so please upload your Form 1098-E Student loan Interest

Upload Requested Documents

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS

Upload ID/DL (for anyone over 18 years old on this filing) *

(In order to file HOH upload lease and utility bill in your name) If filing single only a utility bill is needed *

Upload Social Security Card (for all listed on this filing) *

Please upload all W2's Here- You can upload multiple files

If you received Unemployment Please Provide 1099-G form

Withdrawal out of 401K? Please attach documentation if available.

Please provide Mortgage / Property Tax form(s) if paid taxes/insurance

Please Upload any Additional Tax Forms that you have Received.

Please upload Birth Certificates for all dependents.

Upload copy of prior year tax return or transcript (include the schedule c if was self employed)

Banking Information

Do you owe or have you owed the IRS? *

yes

no

Will you want any of the following Bank Products? (Choose All That Apply ) ** Please note all bank products must go through an approval process and will require a written authorization Form 7216 Bank Consent to Disclosure of Tax Return Information *

Tax Refund Advances

Deduct Tax Preparation Fee from your refund

If you want a tax loan advance: *

Do you want the $1000 advance (no finance charge)

Up to $7500 (with finance charge)

Or not interested in a tax refund advance loan

I have read and agree to the KYMAJ Consent to Disclosure of Tax Return Information (Form 7216) *

agreement

Client Signature - Consent to Disclosure (Form 7216) *

Clear

Full legal signature required (no scibble or initals)

How would you like your refund to be deposited when ready? *

Direct Deposit

I have tax obligation and will not be receiving a refund

Paper check printed at the office

Bank Name *

Is this a checking or savings account? *

checking

saving

Routing Number *

Confirm Routing Number *

Account Number *

Confirm Account Number *

Due Diligence Questions

Have you ever been disallowed the Earned Income tax Credit, The additional child Tax credit, or the Child tax credit? *

yes

no

If you are a single parent, Where's the other parents of your child/children? *

What is the name of the other parent(s) *

Why is the other parent not claiming the child? *

If you are divorced or separated, when did you last live in the same home?

Do you have joint custody of your child? (If so which child/children)

How long did your child/children live in the other parent's home during the tax year? (in months) *

Do you have a signed form 8332 granting the right to claim this child/children? *

yes

no

not needed

not applicable

Did anyone else live in the home that provides financial support for your child/dependents? *

yes

no

not applicable

Can or could anyone else be eligible to claim this dependent on their tax return? *

Did you pay someone to watch your child/children? *

yes

no

If so please upload any childcare statements.

Did you receive any type of supplemental, non taxable income such as child support, Welfare benefits, Social security, etc? *

yes

no

In the case of a random IRS audit, can you provide for the children: *

School Records

Medical Records

Signatures

Please Review & Sign Consent Forms

I have reviewed and agree to the KYMAJ Client Engagement Letter *

agree

Client Signature (required) *

Clear

IRS Consent to Use and Disclosure of Tax Return Information *

I authorize KYMAJ to use and disclose my tax return information as allowed by federal law

Client Signature (required)

Clear

I have read and agree to authorize KYMAJ to electronically file my federal and/or state tax return *

agree

Client Signature- E-File Authorization (Form 8879) *

Clear

By typing your Name, Signature, and Date, you agree that all information entered on this form is true and correct.

I confirm that all information I have entered here is accurate and true.
I allow KYMAJ to capture my sensitive data like personal ID, government ID, Social Security Number (SSN), and other information.
By typing your name below and signing your signature, you acknowledge that you have read and understood your responsibilities and our responsibilities in completing this tax return.

Type Your First and Last Name *

Signature *

Clear

Today's Date *

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