Information Sheet – Renter 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 Address Line 2 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)How much did you pay for heating your home/apartment?Cost of License PlatesCollege for you or a dependent?YesNoChurch/Charitable Cash/CheckStudent Loan Interest PaidChurch/Charitable Non-CashHow 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?RentingIf you are renting, we need the amount of rent YOU paid. (This does not include any money paid by others living in the same home.) If you MOVED during the year, we need this information for each place that you stayed.Address where you lived: (YOU PAID) Last yearMonthly Amount (YOU PAID)# of Months Last Year Landlord's Name AND Address:Other Address where you lived last yearMonthly Amount (YOU PAID)# of Months Last Year Other Landlord's Name AND Address: 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 #CheckingSavingsPhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.