5 Starr Tax Professionals

1804-A Barataria Blvd Marrero LA 70072

3401- C Plank Rd. Baton Rouge LA 70805

504-345-2354 / 225-250-5300

www.5starrtaxpros.com

Thank you for allowing us to prepare your tax return. It is very important you provide ALL Information requested in this form to help our qualified staff in completing your return. If you have any questions, please ask, you will need your:

Tax information such as Forms W-2, 1099, 1098
Social security cards or ITIN letters for you and all persons on your tax return.
Proof of identity (government issued photo ID such as driver's license, state ID or other photo ID).

Please Select Preparer of your choice *

. Part 1: Your Personal Information

Name :

First Name *

Last Name *

Date of birth *

SSN/ITIN : *

Occupation

US Citizenship

Yes

Legally Blind :

Yes

Permanently Disabled :

Yes

Spouse Name

Spouse Date of Birth

Spouse SSN/ITIN

Spouse Occupation

Legally Blind (Spouse)

Yes

US Citizen (Spouse)

Yes

Permanently Disabled (Spouse)

Yes

Address

#Apt

State

City

Postal code

Phone *

Cell Phone Accept Text

Yes

Email *

Filling status

Head of Household Qualifying Documents Lease, Utility Bills, etc.

DO YOU RECEIVE GOVERNMENT ASSISTANCE? IF SO, LIST BELOW

. Part 2: Dependent Information

List below the name of everyone who lived in your home and outside your home that you supported during the last tax year. If additional space is required, please check here and use an additional page for additional information.

Name and Info of Child 1 :

Full Name of Child 1

Relationship to child 1

Months of Child 1 living with You

Child 1 Date of Birth

Social Security # of Child 1

How many children do you have? (PLEASE TYPE (0) FOR NONE)

Name and Info of Child 2 :

Full Name of Child 2

Relationship to child 2

Child 2 Date of Birth

Social Security # of Child 2

Months of Child 2 living with You

DID ANYONE ATTEND COLLEGE?

YES

DID ANYONE ATTEND DAYCARE/ AFTERCARE

YES

UPLOAD ALL SOCIAL SECURITY CARDS, BIRTH CERTIFICATES, IDENTIFICATION, CHILDCARE FORMS, AND COLLEGE 1098-T STATEMENTS HERE*

PLEASE LIST ADDITIONAL DEPENDENTS OR WHY ANY DOCUMENTS ARE MISSING BELOW

. Part 3: Bank Information

How would you like your IRS refund issued?

Bank Name

9-Digit Routing Number

Bank Account Number

Account Type

CHECKING

SAVINGS

. Part 4: Questionnaire

How did you hear about us? If you were referred, by who?

Signature *

Clear

Spouse Signature

Clear

Signature Date