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Taxpayer Information form
Please take a few minutes to fill out the information below
You can also
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this form, fill it out and bring it to our office
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Are you a returning ACMM Consulting Client?
*
Yes
No
Are there any changes in the dependent information from last year?
*
Yes
No
GENERAL INFORMATION
Primary Taxpayer
Full Legal name
*
Social Security or ITIN Number
*
Date of Birth
*
Marital Status
Email Address
*
Mobile phone
Work phone
Home phone
Occupation
Head of the household?
*
Yes
No
Secundary Taxpayer
Full Legal Name(2)
Social Security or ITIN Number(2)
Date of Birth(2)
Marital Status(2)
Email Address(2)
Mobile phone(2)
Work phone(2)
Home phone(2)
Occupation(2)
Head of the household?(2)
Yes
No
ADDITIONAL INFORMATION
Preferred Contact Method?
English
Spanish
Can you be claimed as a dependent by someone else?
Yes
No
Would you like your federal or state income tax refund by direct deposited?
Yes
No
Name of Bank
Account Number
Routing Number
DEPENDENTS
(or person living in your household)
Name(D1)
Relationship(D1)
Date of Birth(D1)
SSN or ITIN(D1)
Full Time Student(D1)
Disabled(D1)
Name(D2)
Relationship(D2)
Date of Birth(D2)
SSN or ITIN(D2)
Full Time Student(D2)
Disabled(D2)
Name(D3)
Relationship(D3)
Date of Birth(D3)
SSN or ITIN(D3)
Full Time Student(D3)
Disabled(D3)
CHILDCARE INFORMATION
Provider Name
Provider Address
Provider SSN/EIN
Amount Paid
Provider Name(2)
Provider Address(2)
Provider SSN/EIN(2)
Amount Paid(2)
Provider Name(3)
Provider Address(3)
Provider SSN/EIN(3)
Amount Paid(3)
INCOME
(Check all that apply & include documents)
Employer (W-2)
1099-Misc
IRAS
Self-Employment
Interest (1099Int)
Alimony
Social Security/Retirement
Dividends (1099-Div)
Rental Property
Stock/Mutual Fund Sale (1099-B)
Unemployment
Other Income not listed
EXPENSES
(Check all that apply)
Self-Employment
Un-reimbursed by your employer
Education
Rental Property
Medical/Dental care
Union Dues
Moving cost
Travel
Automobile
CREDIT & DEDUCTIONS
(Check all that apply.)
Donate cash or goods to a charity?
Pay Student Loan interest?
Pay Child/Depent care expense?
Have a Mortgage Payment? (1098)
Make an IRA Contribution?
Purchase a hybrid vehicle?
Make a major taxable purchase?
Pay Property Taxes?
Made energy efficient improvements?
HEALTH INSURANCE
(Check all that apply & include documents.)
Obamacare (Marketplace)
Employer Insurance
Medicare or Medicaid
Other
MISCELLANEOUS
(Check all that apply. )
Sell or buy a home?
Take an IRA or 401(k) distribution?
Adoption expenses?
Have household help?
Suffer catastrophic loss?
UPLOAD RELATED DOCUMENTS
Multiple files
By entering my name below, I confirm the information I provided is true and accurate to the best of my knowledge.
Primary Taxpayer Name
*
Primary Date
*
Secondary Taxpayer Name
Secondary Date
Submit
Homepage
About us
Our Services
Operational and Strategic Planning
Accounting Solutions
Individual and Corporate Tax Consulting Services
Organizational Development and Corporate Strengthening
Taxpayer Information form
Industries We Serve
Real Estate: Residential and Commercial
Consumer Business
Manufacturing
Public Sector
Legal
About ACMM
Terms of Use
Privacy
Cookies
.
Contact us
COVID-19 Update
Blog
