Virtual Tax Preparation Step 1 of 7 14% 1. Virtual Tax PreparationFor your convenience submit your taxes virtually 24/7! Who is Your Tax Preparer?*Melanie DenhamNadine HastyTira J.Althea SamuelsClick on the name to change the choiceWho Referred You? Legal Full Name* First Middle Last Date of Birth* MM slash DD slash YYYY Social Security Number* Phone Number*Phone ProviderEmail Address* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your address different from last years tax return? Yes No Are you legally married? Yes No If you are married filing separately or married filing jointly please fill out the Spouse info below. Spouse Name First Last If MarriedSpouse Date of Birth: MM slash DD slash YYYY Spouse Phone NumberPhone ProviderSpouse Email Address Spouse Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country If living separatelyDid you, your spouse, or a dependent have insurance under the Affordable Care Act in 2023? ** Yes No If so, select Yes – you must report Form 1095-A for the IRS to accept your return. If you did not have an Affordable Care Act insurance plan, select No. Please attached the 1095-A received by the IRS before you submit this application, your tax return will not be accepted if this form is not reported. 2. DependentsA dependent is a qualifying child or a qualifying relative that you support. Dependent 1 First Middle Last Please make sure to enter the name of your dependent(s) the way that it was entered on previous returns filed with the IRS. Dependent SSN: Dependent Date of Birth MM slash DD slash YYYY RelationshipSonDaughterNephewNieceGrand DaughterGrand SonBrotherSisterDid Your Dependent Live With You More Than Half The Year? Yes No Dependent 2 First Middle Last Please make sure to enter the name of your dependent(s) the way that it was entered on previous returns filed with the IRS. Dependent SSN: Dependent Date of Birth MM slash DD slash YYYY RelationshipSonDaughterNephewNieceGrand DaughterGrand SonBrotherSisterDid Your Dependent Live With You More Than Half The Year? Yes No Dependent 3 First Middle Last Please make sure to enter the name of your dependent(s) the way that it was entered on previous returns filed with the IRS. Dependent SSN: Dependent Date of Birth MM slash DD slash YYYY RelationshipSonDaughterNephewNieceGrand DaughterGrand SonBrotherSisterDid Your Dependent Live With You More Than Half The Year? Yes No Dependent 4 First Middle Last Please make sure to enter the name of your dependent(s) the way that it was entered on previous returns filed with the IRS. Dependent SSN: Dependent Date Of Birth MM slash DD slash YYYY RelationshipSonDaugterNephewNieceGrandaughterGrandsonBrotherSisterDid Your Dependent Live With You More Than Half The Year? Yes No 4. Sworn StatementPlease Fill Out Form Only If You Have Dependents Dates the dependent(s) lived with you in Calendar Year 2023 Address that your dependent(s) lived at with you in Calendar Year 2023. (If moved put address that they lived with you for more than half a year) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country List All Dependents That Lived With You From Your Tax Return Please Check I am certifying that the dependents listed above that I am claiming on my 2023 tax return has lived with me at the address above for more than 6 months in 2023 in the United States. Single Choice School Records Medical Records Daycare Records Lease Agreement Other If Other, List Below: I hereby affirm under penalty of perjury that the facts set forth in this statement are true Tax Payer Name Tax Payer SignatureToday's Date MM slash DD slash YYYY All income earned and unearned must be reported as income on your tax return. If your source of income is not listed below, click the other option. You will have a chance at the end to upload all your income-related documents.Income Recieved* Wages or Salary Business/Self Employment Interest/Dividends Pension Unemployment Social Security Benefits Alimony Received Real Estate Sales Gambling Winnings Gifts/Prizes/Awards/ Bonuses Estate/ Trust Sale of Principal Residence Other What is your occupation?* If your income is business income, what is the name of your business? If you have a business we will send you a separate email with a spreadsheet to record your expenses. Business EIN Number Did you have a vehicle that you used for your business? Please include the year, make and model of the vehicle. Including your vehicle information is pertinent to saving on your income taxes as a business owner. If you selected other income explain that income below: Did you itemize deductions last year? Yes No Please check all your itemized deductions Medical and Dental Expenses Job Expenses Gifts to Charity Mortgage Interest Paid Tithes and Offerings 401 IRA Contributions Health Savings Account Contributions Educator Expenses Residential Energy Electric Vehicle Tax Credit List out each itemized deduction amountMake sure to include the amount you spent on each deduction. Itemized deductions are amounts that can be subtracted from your Adjusted Gross Income that will reduce your tax liability(taxes owed). Did you or any of your dependents attend college or any type of educational training? Yes No If you attended college or any educational training please upload the 1098-T received or the information at the end of this application. Consent to Use CONSENT TO USE OF TAX RETURN INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean One Stop Tax Spot Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage in our tax return preparation services. If we obtain your signature on this form by conditioning our tax preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee. For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information. By signing below, you authorize us to use the information you provide to us during the preparation of your 2023 tax return to determine whether to present you with the opportunity to apply for these products and services.Name* First Last Date MM slash DD slash YYYY Signature*Spouse Name First Last (if applicable)Date MM slash DD slash YYYY SignatureIf you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at [email protected] Consent to Disclose CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean One Stop Tax Spot LLC Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature. You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Pathward, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your 2023 tax return information necessary for evaluating the request to Pathward. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your 2023 tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information. By signing below, you authorize us to disclose to Refund Advantage all of your 2023 tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Refund Advantage, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee. Name* First Last Date MM slash DD slash YYYY Signature*Spouse Name First Last (if applicable)Date MM slash DD slash YYYY SignatureIf you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at [email protected] Tax Refund/ How would you like to get your tax refund?If you are going to receive an income tax refund you will need to choose between direct deposit, a debit card , or a check. Would you like to apply for an Advance Loan?NoYesTax refund advance loans are short-term loans that are repaid through your upcoming IRS tax refund. Loans are usually offered from December through February, and amounts can range from $100 to $6,500. How would you like to receive your tax return?*Direct DepositDebit CardCheckI am not getting a refundClick on the box to change the selection.Attach The Bank Account Information For Your Tax Refund Enter your bank information only if you are having your tax refund direct deposited to your checking or savings account. If you don’t enter your bank information you will automatically receive a paper check (Mandatory for direct deposits)Bank Name Checking or Savings Account Checking Account Savings Account Bank Routing Number Bank Account Number Did you receive an IP Protection PIN from the IRS? If so what is it? (IF APPLICABLE)This is a pin the IRS gives you file with your tax return if you have had issues with security on your tax return in the past, and cannot be accepted and filed without it.Please attach all documents that apply to you or your dependents: A PICTURE ID MUST BE ATTACHED FOR YOUR TAX RETURN TO BE FILED* Drop files here or Select files Max. file size: 100 MB. (Valid Picture ID, Copy of Social Security Cards, W2s, 1099s, Healthcare Forms, Proof of Residency, )Explanation of Documents (ex. W2, 1099 ) Dear Client: We appreciate the opportunity of working with you and advising you regarding your income tax. To ensure a complete understanding between us, we are setting forth the pertinent information about the services that we will perform on your behalf. By signing this document I acknowledge that all information in my 2023 federal and state tax return that include, but not limited to my earned and unearned income, expenses, deductions, dependents, and other information is true and accurate to my knowledge. This letter will serve as our agreement in this matter and we ask that you carefully review the letter and sign to confirm all of the information contained within. It is your responsibility to provide us with all the information needed to prepare complete and accurate tax returns. We will not or otherwise verify the data you submit, although we might ask you to clarify some of the data. If in the event that you supply us verbally with any tax information, by signing this letter you are confirming that the information provided is true and correct to the best of your knowledge. For those clients who are claiming the Earned Income Tax Credit, Additional Child Tax Credit, Education Credit, or The Head of Household (Filing Status), I acknowledge that all questions that were asked, information that was provided, and information regarding any dependents that allows me to qualify for any of these credits is true and correct to the best of my knowledge. Qualifying Children for EITC1. Relationship – The person must be related to you in some way. They can be your: Son, daughter, stepchild, eligible foster child, adopted child, or a descendant of any of them (e.g. your grandchild) Brother, sister, half brother, half sister, stepbrother, stepsister, or a descendant of any of them (e.g. your niece or nephew) 2. Age – The person can be either: Under age 19 at the end of the year – if you file a joint return, they must be younger than either you or your spouse. A full-time student under age 24 at the end of the year – if you file a joint return, they must be younger than either you or your spouse. Permanently and totally disabled at any time during the year, regardless of age 3. Residency – The person must have lived with you for more than 6 months 4. Joint return – You cannot claim anyone as a qualifying child who is filing a joint return. You can, however, claim someone as a qualifying child who is filing as married filing separately or any other filing status. A person cannot be claimed as a qualifying child by more than one person. If this is a situation you think you will encounter, the IRS has provided tiebreaker rules. I understand that this information is being provided to the IRS and State Revenue. I have been advised by my tax preparer that any false and misleading information that I provide for income tax filing purposes is against the law and are subject to penalties. I understand that One Stop Tax Service is only liable for any Error and Omission on their part and will be responsible for any interest and penalties and not tax due. As you know, tax returns are subject to examination by various taxing authorities at both the state and federal levels. In the event of an examination or audit, you may be requested to produce supporting documents or records to substantiate the items of income or deductions. If an examination or audit takes place, One Stop Tax Service stands ready to work with you. Upon completion of your returns and after you have paid your tax preparation fees we will provide you with a copy of your return. You should review the completed returns carefully. If you see anything that requires changing please bring it to our attention immediately and we will either explain the matter to you or correct it without delay and provide you with new, corrected copies. Fees for our services will be at our standard rates for tax matters. Our fees for tax preparation are based on the complexity of the return and the number of schedules and forms necessary and required by the taxing authorities to complete an accurate return. Our invoices are due and payable on presentation. The only exception to fees not being due on presentation is if the taxpayer chooses to select payment to be deducted from refund. If refund is offset for any reason, the balance is still due and you will be billed for payment, which will be due immediately. As your Tax Preparer, we collect information provided by you from your tax organizer, worksheets, documents, discussions, and information that we develop as part of the engagement. We are required to keep all information about our engagement confidential so we will not make any disclosure about you unless we have your approval or are required/permitted by law. This applies even if you are no longer a client. We are committed to safekeeping of your confidential information and we maintain physical, electronic, and procedural safe guards to protect it. By signing this letter, you authorize us to communicate with you regarding any and all products which we offer via phone, email, fax, and/or letter format. Please sign a copy of the letter. We appreciate the opportunity to be of service to you and look forward to working with you and on your behalf. If you should have any questions or need additional information, please do not hesitate to call or email us at : [email protected]/ 770-742-9877Name* First Last Date MM slash DD slash YYYY Signature*Spouse Name First Last Date MM slash DD slash YYYY SignatureIs there any additional information that you would like to provide us?
