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TAX INTAKE FORM

Birthday
Month
Day
Year
Multi-line address
Can someone else claim you as a dependent on their tax return?
Yes
No
Are you married filing jointly?
Yes
No
Do you have any dependents?
Yes
No
Did you pay child care expenses for any dependents listed above?
Yes
No
Did you receive child tax credit for 2024?
Yes
No
Did you, your spouse, or any dependents attend college in 2024?
Yes
No
Did you, your spouse, or dependents receive health insurance through the Marketplace in 2024 and receive Form 1095-A?
Yes
No
If you own your home, have you received your form 1098 from your mortgage lender?
Yes
No
Did you or your spouse make payments on your student loans in 2024?
Yes
No
Did you or your spouse receive unemployment benefits in 2024?
Yes
No
Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support, etc?
Yes
No
Any new addition in 2024? (New baby or Adoption)
Yes
No
Do you own a business? (Did you own a business or have a side job in 2024?)
Yes
No
Did you receive a 6-digit IDENTITY PROTECTION PIN
Yes
No
Account Type
How did you hear about us?

I acknowledge that all information provided to Blessd Hands Tax Services is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to facing court dates restitution, and possible imprisonment. I waive Blessd Hands Tax Service and the preparer of any error due to incorrect information provided by me. By signing this, I allow Blessd Hands Tax Service to file my tax return.

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