Client Tax Data Sheet

Fill out the form below to submit your tax information to me. If you have any questions prior to completing this form, do not hesitate to contact me by email info@jlwtaxfinancial.com or by phone at (234) 231-9141. Thank you and have a great day!

How did you hear about us or who referred you?

First Name *

Middle Name

Last Name *

Suffix

Date of birth *

Occupation *

TAX ID/SSN# *

Address *

Address Line 2

City *

State *

Postal code *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Email *

State Driver's License Was Issued

Driver's License #

Driver's License Expiration Date

Photo of Social Sec. Card & Driver's License

Choose File - Driver's License ID/ SSC

What is your filing status? *

Are you filing an eligible spouse on your tax return?

Yes

Date Driver's License Was Issued

Spouse Name

Spouse Social Security Number

Spouse Occupation

Spouse Date of Birth

Spouse Email

Address Line

Spouse Driver's License #

Spouse State Driver's License Was Issued

Spouse Date Driver's License Was Issued

Spouse Driver's License Expiration Date

Spouse's Photo of Driver's License & Soc Sec Card

Choose File - Driver's License ID/ SSC

Dependents

Should only be listed if you take care of the dependent over half of the year

Image of All Dependent's S.S.Cards

Upload ALL here

1. Dependent Information

Gender of Dependent

Dependent's First Name

Dependent's Middle Name

Dependent's Last Name

Dependent's Suffix

Dependent's Date of Birth

Social Security Number Dependent

2. Dependent Information

Gender of Dependent 2

Dependent's First Name 2

Dependent's Middle Name 2

Dependent's Last Name 2

Dependent's Suffix 2

Dependent's Date of Birth 2

Social Security Number Dependent 2

3. Dependent Information

Gender of Dependent 3

Dependent's First Name 3

Dependent's Middle Name 3

Dependent's Last Name 3

Dependent's Date of Birth 3

Social Security Number Dependent 3

4. Dependent Information

Gender of Dependent 4

Dependent's First Name 4

Dependent's Middle Name 4

Dependent's Last Name 4

Dependent's Suffix 4

Dependent's Date of Birth 4

Social Security Number Dependent 4

Do you have Dependent Daycare Expenses?

1) Yes

2) No, all dependents are entered

Child and Dependent Daycare Expenses

Child's Name

Amount Paid

Provider

Provider's Name

If the provider is a person, enter the care provider's SSN, if business, enter EIN.

Provider Tax ID# / SSN

Provider's Full Address

Provider Phone Number

Do you want to enter another child care provider?

1) Yes

2) No

Business Owners Data Sheet

Schedule C

Name of Business

Employer ID Number

What is the legal structure of your business?

Business Address

Amount Paid ($)

Business Income

All income receive during the fiscal year

Total Income

Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.

Advertising

Contract Labor

Insurance

Interest

Legal & Professional Services

Office Expenses

Rent and Lease

Repairs and Maintenance

Supplies

Taxes and Licenses

Travel, Meals, and Entertainment

Utilities

Other Expenses

Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?

Attach any photos or documents that you want us to have on file.

Choose Files

I agree to terms & conditions

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