First Name *

Last Name *

Phone *

Email *

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Street Address *

City

State

Country

Postal code

Social Security *

Date of birth

Occupation *

Filing Status at the end of 2025 *

Spouse's Full Name

Spouse's Phone Number

Spouse's Email Address

Spouse's Social Security Number

Spouse's Photo Identification

Photo ID Number

State Photo ID was issued

Date Photo ID was issued

Date Photo ID expires

If Widowed and your spouse died after 12/31/2021, enter the date of death:

If Married but filing separately, did you live apart from spouse for the last 6 months of 2025?

Tax Payer's Photo ID *

Account Information for Deposits & Withdrawals

Name of Bank:
Routing Number:
Account Number:
Type of Account:
Use this Account for:

Do you have dependents? *

If Yes, list dependent(s) Name, DOB, Social Security,

Did you have childcare/dependent care expenses?

If YES: Submit proof of childcare

Did you receive health coverage through Marketplace? 18y82

If Yes: Submit Form 1095

Did you receive health coverage through your employment? 17ds9

If Yes: Submit Form 1095