INCOME TAX PREPARATION QUESTIONNAIRE

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Our Office Location:

2909 E Arkansas Ln Suite C-111

Arlington, TX 76010

Website: www.optimumtaxpro.com

Email: info@optimumtaxpro.com

Helpline: 469 557 1040

This questionnaire has been divided into sections and may take you upto 30 minutes to complete. Organize all your tax documents and save yourself the hassle of having to come to our location to get your taxes done.

Tax Payer Information

First Name *

Middle Initial

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Occupation *

SSN or ITIN (Your Social Security Number or Individual Tax Identification Number)

Date of Birth *

Date of Death (if Applicable)

Are you Legally Blind? *

Yes

No

Filing Status

Filing Status *

Spouse Info

First Name *

Middle Initial

Last Name *

Street Address *

Street Address Line II *

City *

State *

Zip Code *

Phone Number *

Occupation *

SSN or ITIN (Your Social Security Number of Individual Tax IdentifIcation Number)

Date of Birth *

Date of Death (if Applicable)

DEPENDENT INFORMATION

Are you claiming dependant? *

Yes

No

How many dependent(s) are you claiming ? *

Dependant I

First Name *

Middle Initial *

Last Name *

SSN or ITIN (Your Social Security Number of Individual Tax IdentifIcation Number)

Date of Birth *

Date of Death (if Applicable)

Relationship *

How long lived with taxpayer during the tax year ? *

Can this dependent be claimed as dependent on someone else's tax return ? *

Does this dependent have education expenses ? *

Our Staff will contact you to request additional information

Dependant II

First Name *

Middle Initial *

Last Name *

SSN or ITIN (Your Social Security Number of Individual Tax IdentifIcation Number)

Date of Birth *

Date of Death (if Applicable)

Relationship *

How long lived with taxpayer during the tax year ? *

Can this dependent be claimed as dependent on someone else's tax return ? *

Does this dependent have education expenses ? *

Dependant III

First Name *

Middle Initial *

Last Name *

SSN or ITIN (Your Social Security Number of Individual Tax IdentifIcation Number)

Date of Birth *

Date of Death (if Applicable)

Relationship *

How long lived with taxpayer during the tax year ? *

Can this dependent be claimed as dependent on someone else's tax return ? *

Does this dependent have education expenses ? *

If you have more than 3 dependents, no problem. You can add their information at the final part below.

EDUCATION

Did you go to school last year? 🛈

Yes

No

Name of Educational Institution *

Street Address *

Address Line 2

City *

State/Province/Region *

Zip/Postal Code *

Phone Number *

Country *

Have you received your form 1098T from your school? *

Yes

No

SCAN/SNAP AND UPLOAD YOUR DOCUMENT

Health Insurance

Did you have qualifying Health Insurance Coverage last year? *

Yes

No

Did Exchange Provided you Health Coverage last year? * 🛈

Yes

No

PRIOR YEAR TAX RETURN

Did you file taxes last year?

Yes

No

Your Last Year Adjusted Gross Income

Your Filing Status for last year *

Refund Options

How would you like to receive your tax refund money ? *

Direct Deposit

Debit Card

Paper Check

Bank Account Type *

Checking

Saving

Other (Specify) Other (Specify)

Name of Bank *

Account Name *

Account Number *

Routing Number *

Taxpayer IDENTIFICATION

Tax Payers ID Type *

Taxpayer ID number *

Taxpayer ID Issue Date *

Taxpayer ID Expiring Date *

Taxpayer ID State of Issuance *

FINAL PART - SCAN/SNAP AND UPLOAD YOUR DOCUMENTS

Scan and Upload your relevant tax documents here if available. (e.g W2s, 1099s, Social Security Cards, ID Cards etc)

Comments or Additional Information *

How did you know about us? *

Please sign below that you understand and agree to the terms and conditions: *

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