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CircuitCity
Tax Preparation Information Sheet
Please Fill Out This Form Completely. Fields with a * are mandatory.
Taxpayer Information
Spouse Information
S.S. #
First Name*:
First Name:
Last Name*:
Last Name:
D.O.B.:
Telephone:
Mailing Address:
(if different)
Zip Code
City, State:
E-Mail*:
Dependent Information:
Age:
SSN
Relationship
Clergy:
Books:
$
Equipment:
Conferences:
Office supplies:
Home Maintenance:
Furlough Funds:
Housing Allowance:
Furlough Meals:
Housing:
Furlough Hotels:
Medical Expenses:
Printing/Newsletter:
Property Taxes:
Postage/Shipping
Reserve Funds:
Taxes Paid US Federal:
Retirement Fund:
Taxes Paid Foreign:
Travel Expenses:
Tithe/Charity:
Total
Tuition:
Utilities
General Helpful Information:
How many W-2’s ?
How many 1099’s (R, Misc., etc.)
How many 1098’s (mortgage interest)
Do you have an approved 4361 SS Exemption Form? Yes or no
How many days were you in the USA?
Please enter any addition information of a message below:
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