750 Tax Agency Form

Today’s Date * +

Do you want to file or receive a quote? *

File my taxes

Receive a quote

Admendment

Name of person who referred you?

Which year are you filling for? *

2020

2021

2022

2023

Filing status? *

Do you have a state return you need to file as well? *

Yes

No

If you need to file a state return, please list the state(s).

Taxpayer Information

First Name *

Last Name *

Phone Number *

Date of Birth *

Social Security Number *

Street Address *

Address Line 2 *

City *

State *

Zip Code *

Email Address *

Occupation *

Do you own and operate a small business/home based business? *

Yes

No

If yes, please enter your EIN if applicable

Upload taxpayer photo identification *

Upload taxpayer social security card *

Upload taxpayer income documents

Spouse Information

First Name

Last Name

Date of Birth

Social Security Number

Phone Number

Occupation

Upload spouse photo identification

Upload spouse social security card

Upload spouse income documents

Refund Options

Would you like to apply for the Tax Advance? Up to $7,000? *

Yes

No

If yes, how would you like your refund to be deposited when ready? (If you did not opt into the advance loan)

Check

Direct Deposit

Prepaid Debit Card

If direct deposit, please list bank name

Routing Number

Account Number

Account Type

Checking

Savings

Are there any other issues or concerns regarding this year or any previous year return? If yes, please explain. *

Dependent Information

If your are claiming dependents, please enter their information below

	Name	SSN	Date of Birth	Relationship
1	Name	SSN	Date of Birth	Relationship
2	Name	SSN	Date of Birth	Relationship
3	Name	SSN	Date of Birth	Relationship
4	Name	SSN	Date of Birth	Relationship
5	Name	SSN	Date of Birth	Relationship
6	Name	SSN	Date of Birth	Relationship
7	Name	SSN	Date of Birth	Relationship

Upload dependent(s) social security card(s)

Did you pay any childcare expenses for any dependents listed above? *

Yes

No

Child care provider name

Total amount childcare paid in 2022

Upload childcare receipts

Tax Related Questions

Did you, your spouse, or any dependents attend college in 2022? *

Yes

No

If yes, the student's first and last name

Did the student attend college at least half time?

Yes

No

Upload Form 1098-T from college

Did you, your spouse or any dependents receive health insurance through the Marketplace in 2022 and received Form 1095-A? *

Yes

No

If yes, upload Form 1095-A Health Insurance Marketplace Statement

Did you or your spouse receive unemployment benefits in 2022? *

Yes

No

Upload Form 1099-G received for unemployment benefits

Do you rent or own your current residence? *

Yes

No

If you own your home, have you received Form 1098 from your mortgage lender?

Yes

No

Upload Form 1098 from Mortgage Lender

Did you or spouse make payments on your student loans in 2022? *

Yes

No

Upload Form 1098-E Student Loan Interest Statement

Are you an educator? *

Yes

No

If you are an educator, please list your total educator expenses for 2022

Do you or your spouse own a rental property? *

Yes

No

Did you or your spouse have any gambling winnings in 2022? *

Yes

No

If yes, upload Form W-2G from gambling winnings

Did you receive any earnings from interest or dividends in 2022? *

Yes

No

If yes, upload Form 1099-DIV and 1099-INT

Did you or your spouse receive social security benefits in 2022? *

Yes

No

Did you or your spouse withdraw money from your 401k in 2022? *

Yes

No

Did you purchase a vehicle in 2022? *

Yes

No

Did you make any charitable contributions in 2022? *

Yes

No

General Expenses

Please enter the information within the current year only. *

	Amount
Medical Expenses	Amount
Dental Expenses	Amount
Insurance Premiums Paid	Amount
Long Term Care Premiums	Amount
Prescription Drugs and Medications	Amount
Home Mortgage	Amount
Job-Related Educational Expenses	Amount
Investment Interest	Amount
Cash Contributions	Amount
Non-Cash Contributions	Amount
Unreimbursed Business Expenses	Amount
Union Dues	Amount
Tax Preparation Fees	Amount
Investment Expenses	Amount

Additional Comments

0/500 characters

Business Expenses-- If this does not apply to you, please skip

What is your business structure?

Do you have an EIN?

Yes

No

Enter your EIN

Upload all supporting documents for your business (IF APPLICABLE). (DBA, receipts, log sheet, flyer, business cards or price list)

Please enter the information within the current year only.

	Amount
Advertising	Amount
Car / Truck Expenses	Amount
Contract Labor	Amount
Legal and Professional Fees	Amount
Office Expenses	Amount
Rent / Lease - Vehicles, Machinery	Amount
Rent / Lease Other Business Property	Amount
Supplies	Amount
Taxes and Licenses	Amount
Travel and Meals	Amount
Travel	Amount
Other Expenses	Amount

Additional Comments

0/250 characters

DUE DILIGENCE QUESTIONNAIRE

The United States Congress have, as a reaction to the substantial tax fraud resulting from their original error of choosing to distribute federal social welfare program benefits via the tax return, placed new excessive inappropriate “due diligence” requirements on paid tax return preparers whose clients are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service, the IRS has forced tax preparers to, in many cases, become Social Workers and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC and now HOH.

We preparers are not compensated by the IRS or the government for doing their job for them but must pass the costs of this required additional work on to our taxpayer clients.

You will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/or an American Opportunity Credit on your 2022 tax return. Because of this you must complete, sign, and return this questionnaire to me. I will keep the original signed copy of this questionnaire with my file copy of your 2022 tax return and will include a photocopy of the completed questionnaire in the package I send you with the finished returns.

I/we certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my/our dependent(s), as per the information provided at the end of this questionnaire. *

Yes

No

Not Applicable

The child(ren) for whom the tax credit(s) will be requested lived with me/us for the year, except for temporary absences. *

Yes

No

Not Applicable

I am the custodial parent of the child(ren) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2022 by signing Form 8332 (Release/Revocation of Claim to Exemption for Child by Custodial Parent). *

Yes

No

Not Applicable

I am not the custodial parent of the child(ren) but I have been given a signed Form 8332 by my former spouse, the custodial parent, allowing me to claim the child(ren) as the dependent(s) on my 2022 tax returns (you must give me the Form 8332). *

Yes

No

Not Applicable

I/we, or my child(ren), have documentation to substantiate the credit(s) being claimed, such as Form 1098-T, bills, statements, and receipts for college tuition, fees, and book and material costs (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned). *

Yes

No

Not Applicable

Was a Child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return? *

Yes

No

Not Applicable

I claim I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household. *

Yes

No

Not Applicable

ATTESTATION AND SIGNATURE

I acknowledge that all information provided to D&R Tax Services is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive D&R Tax Services and the preparer of any error due to incorrect information provided by me. By signing I authorize D&R Tax Services to file my tax return. I acknowlege by signing this form if I and/or my spouse owes a federal/governement debt such as IRS, child support, student loans etc., I/we are still responsible for tax preparation fees due to D&R Tax Services at the time of service. Also, if the federal refund amount is mailed, I/we are still responsible for the tax preparation fees stated on the invoice. If the tax preparation fees are not paid, I understand D&R Tax Services will take legal action to collect the unpaid tax preparation fees.

Taxpayer Signature *

clear

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Spouse Signature

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