Taxpayer Name *
Taxpayer Name
Spouse Name
Spouse Name
General
Do you want $3 to go to the Presidential Election Campaign Fund? *
What is your filing status? *
Do you want to use direct deposit if you get a refund? *
If your answer is yes, fill in data below.
Account type
Income
Did you receive wage income (W-2 or its foreign equivalent)? *
Did you receive interest or dividends (1099-INT, 1099-DIV)? *
Did you receive or pay alimony? *
Did you receive a state refund last year (1099-G)? *
Did you have a business or self-employment (1099-MISC)? *
Did you sell an asset such as stocks, property, house, etc. (1099-B, 1099-S)? *
Did you receive or roll over retirement funds (1099-R, 1099-SSA)? *
For example, an IRA, 401K, 403B, pension, Social security, etc.
Did you receive rental income from a house, farm, etc. (1099-MISC)? *
Did you receive unemployment income (1099-G)? *
Did you receive other income (royalties, prize, jury duty, etc.)? *
Did you receive corporate or partnership income (K-1)? *
Did you have gambling winnings (W-2G)? *
Adjustments
Did you have educator expenses for the classroom? *
Did you have a Health Savings Account (1099-SA)? *
Did you move more than 50 miles for a new job? *
Did you contribute to an IRA? *
Did you have a penalty on early withdrawal of savings? *
Did you pay student loan interest (1098-E)? *
Did anyone in your immediate family have college or trade school expenses (1098-T)? *
Did you have long-term care insurance? *
Did you and your dependents have minimum essential health care coverage for all 12 months? *
If you said “no” to the previous question, do you qualify for one of the exemptions? *
Deductions & Credits
Did you pay daycare for dependents? *
Did you make energy efficient upgrades to your residence? *
Did you pay any foreign tax? *
Schedule A Deductions
Did you have any medical expenses post tax *
These are things like insurance, doctor, dentist, vision, prescriptions, hospital, miles
Did you have any interest? *
mortgage/investment/points/Private Mortgage Insurance
Are you claiming charitable contributions on your schedule A? *
cash/check/credit card/used items/miles
Did you have employee out-of-pocket expenses? *
Did you have gambling losses? *
only if you had gambling winnings
Miscellaneous / Carryover from previous years
Did you elect to take the First-time Homebuyer loan in a previous year? *
Did you claim energy credits in previous years? *
Did you receive a retirement distribution in the last three years? *
Do you need to take a Required Minimum Distribution from a retirement account *
IRA, etc
Did you buy a house or refinance in the last five years? *
Did you pay any state or federal estimated quarterly taxes? *
different than withholding
Are you the owner or signer of a foreign account or the grantor to a foreign trust? *
Taxpayer Information
Head of Household *
Head of Household
Include middle initial in first name
US Address *
US Address
Home Phone *
Home Phone
Mobile Phone
Mobile Phone
Birthdate *
Birthdate
Gender *
Spouse *
Spouse
Include middle initial in first name
Birthdate *
Birthdate
Gender *
Dependent 1
Dependent 1
Include middle initial in first name
Birthdate
Birthdate
Gender
Dependent 2
Dependent 2
Include middle initial in first name
Birthdate
Birthdate
Gender
Dependent 3
Dependent 3
Include middle initial in first name
Birthdate
Birthdate
Gender
Dependent 4
Dependent 4
Include middle initial in first name
Birthdate
Birthdate
Gender
People living in a foreign country
Foreign address
Foreign address
Income allocation
Days worked in country may not be the same as days spent in country
If you have additional dependents please add them here.