PLEASE FILL OUT, PRINT AND INCLUDE THIS FORM WHEN DROPPING OFF YOUR TAXES
FILL OUT ONE FOR EACH ADULT AND DEPENDANT
NAME -
ADDRESS-
PHONE AND CELL-
EMAIL ADDRESS-
OCCUPATION-
FILING STATUS - SINGLE, MARRIED ETC.
DEPENDANTS-
SS #
DRIVERS LICENSE #
FEES TO BE DEDUCTED YES OR NO
CHECK, DIRECT DEPOSIT OR MONEY PUT ON A AMERICAN EXPRESS CARD
MAKE SURE I HAVE TOTALS FOR MEDICAL IF YOU ARE PAYING FOR YOUR OWN INSURANCE
ANY QUESTIONS FEEL FREE TO CALL ME FROM 12-12