Make an Appointment

Please use the form below to make an appointment.

Part I: Taxpayer Information

1. YOUR FIRST NAME MI LAST NAME 2. DATE OF BIRTH
3. US CITIZEN OR ALIEN 4. BLIND (LEGALLY) 5. DISABLED 6. OCCUPATION
 Yes No  Yes No  Yes No
7. SPOUSE'S FIRST NAME MI LAST NAME 8. DATE OF BIRTH
9. US CITIZEN OR ALIEN 10. BLIND (LEGALLY) 11. DISABLED 12. OCCUPATION
 Yes No  Yes No  Yes No
13. ADDRESS CITY STATE ZIP
14. Phone Number & Email Address 15. Could you or your spouse be claimed as a dependent on another's income tax return?
Phone:

Email:

 Yes No

16. On December 31st:

Were You:

If married, did you live with your spouse during any part of the last six months of the year?

 Yes No

Is your spouse deceased? If yes, provide the date of death. (mm/dd/yyyy)

Part II: Family and Dependent Information – Do not include you or your spouse.

List everyone who lived in your home and outside your home that you supported during the year.

Name (first, last)

Date of Birth (mm/dd/yyyy)

Dependent Relationship

Months Living With You

US Citizen?

Full-time Student

 Yes No  Yes No
 Yes No  Yes No
 Yes No  Yes No
 Yes No  Yes No
 Yes No  Yes No

Part III. Income – Did you (or your spouse) receive:

 Yes No 1. Wages or Salary (include W-2s for all jobs worked during the year)
 Yes No 2. Tip income
 Yes No 3. Interest/Dividends from: checking or savings account, bonds, CDs, or brokerage account
 Yes No 4. State tax refund (may be taxable if you itemized last year)
 Yes No 5. Self Employment Income -business, farm, hobby, 1099-Misc or any earned income not reported on W-2
 Yes No 6. Alimony income
 Yes No 7. Sale of Stock, Bonds or Real Estate
 Yes No 8. Disability income
 Yes No 9. Pensions, Annuities, and/or IRA distributions
 Yes No 10. Unemployment (1099-G)
11. Social Security or Railroad Retirement Benefits (1099-SSA or RRB)
 Yes No 12. Other Income: Identify

Part IV. Expenses – Did you (or your spouse) make or have:

 Yes No 1. Alimony payments (if yes, you must provide the name and SSN of the recipient)
 Yes No 2. Contributions to IRA or other retirement account
 Yes No 3. Educational expenses for you, your spouse and/or dependents
 Yes No 4. Un-reimbursed medical expenses
 Yes No 5. Home mortgage payments (interest and taxes – see Form 1098)
 Yes No 6. Charitable contributions
 Yes No 7. Child/dependent care expenses that allow you (and your spouse -if married) to work
 Yes No 8. Any estimated tax payments for this tax year
 Yes No 9. Was EIC previously disallowed? (if yes, you may not be eligible for EIC)

Please select a date to have your taxes done:

Please select an alternate date to have your taxes done: