Information Sheet – Homeowner New Customer?Existing Customer?When was the last time XAT TAX prepared your taxes?How did you hear about us?Taxpayer Name (as it appears on Social Security Card)SSNBirth Date Spouse Name (as it appears on Social Security Card)SSNBirth Date Street Address (your current mailing address) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell PhoneDaytime PhoneEvening PhoneEmail address Your OccupationSpouse Occupation If you are NOT claiming Head of Household check here If you are married you must file Married Filing Joint or Married Filing Separate unless you are separated and have not lived together at any time after June 30. Dependent's Full Name As it appears on Social Security CardBirth DateSSNRelationship (Son/Daughter! Niece/Nephew! Brother/Sister/etc)Disabled?College Student?Months in Home last year Child CareName of Child Care Provider (if any)AddressSSN or EIN $ Paid for child care (add a row for each additional child) Are any other adults living in the household?YesNo The amount you paid for any of the following items this year:(You must have documentation in the event you are audited by IRS)College for you or a dependent?YesNoChurch/Charitable Cash/CheckStudent Loan Interest PaidChurch/Charitable Non-CashCost of License PlatesMortgage Interest PaidHow much did you pay to heat your homeProperty Taxes PaidTaxable value of your houseHow much unemployment did you receive?Do you have a foreign bank account?YesNoHow much is in the account?How much FIA/FIP did you receive?How much child support did you receive? I, the undersigned, hereby certify that all of the information provided above is true and correct to the best of my knowledge. I further certify that all of the documents and information required to properly complete my tax return have been supplied to the preparer. Sign below by typing your name. This is legally binding.Full Name* Date* Full Name Date Direct Deposit Info USE SAME ACCOUNT AS LAST YEAR Bank NameAccount #Routing #CheckingSavingsCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.