New Client Registration Taxpayer informationFirst Name *Middle NameLast NameStreet Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemen Arab Rep.Yemen DemocraticZambiaZimbabwePhone *Email Address *SSN/ITIN *Occupation *DOB *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924Is this applicable to you? *BlindCan be claimed as a dependent by another individualWould you like to contribute $3 to the presidential election campaign fund?Permanently and totally disabledSpouse is filing a tax return with the IRS for the first timeClaim exemption for spouse on Married Filing Separately returnSpouse had no income and will not be filing a tax return (married filing separately only)None of the aboveSelect life events that occurred during this Tax Year. *Had a childAdopted a childChanged marital statusChanged employerChanged residenceStarted or sold a businessReceived correspondence from the IRS or a state agencyTaxpayer, spouse, or dependent is a non-U.S. citizenTaxpayer, spouse, or dependent changed name with the Social Security AdministrationTaxpayer, spouse, or dependent received an Identity Protection PIN from the IRSTaxpayer, spouse, or dependent passed awayChanged domicile state (military)None of the aboveWhat is your filing status? *-select-SingleHead Of HouseholdMarried Filling JointMarried Filling SeparateWidowedWill you be claiming children or dependants ?YesNoDid you pay for child care?YesNoIf Yes, How much?Do you own a home or pay a mortgage? *YesNoDid you attend college this tax year? *YesNoName of person who referred youSpouse/Dependent Information (If Applicable)First NameMiddle NameLast NamePhoneEmail AddressSSN/ITINOccupationDOBMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924Is this applicable to you?BlindCan be claimed as a dependent by another individualWould you like to contribute $3 to the presidential election campaign fund?Permanently and totally disabledSpouse is filing a tax return with the IRS for the first timeClaim exemption for spouse on Married Filing Separately returnSpouse had no income and will not be filing a tax return (married filing separately only)None of the aboveDependent InformationNameSSN/ITINDOBMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924RelationshipMonths In HomeDependent Information 2NameSSN/ITINDOBMonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924RelationshipMonths In HomeSelect income sources in this Tax YearWages from employment (W-2)Interest (1099-INT)Dividends and/or distributions (1099-DIV)Retirement plan distributions (1099-R)Social Security benefits (SSA-1099)Sold stocks or investments (1099-B)State or local tax refund (1099-G)Self-employed (1099-NEC)Received Schedule K-1 from a partnership, S-corporation, estate, or trustOwned rental property or collected rent from roommatesReceived alimony from a divorce executed on or before 12/31/2018Gambling winnings (W-2G)Owned or operated a farmMiscellaneous income (1099-MISC)Disability incomeUnemployment compensation (1099-G)Distribution from Coverdell ESA or 529 plan (1099-Q)Distribution from an HSA, Archer MSA, or Medicare Advantage MSA (1099-SA)Income from property sold prior to this year (installment sale)Other income not listed aboveNone of the aboveSelect expenses that applied in this Tax Year.Donations to charity (cash or non-cash)Interest payments (mortgage, vacation home, investments, etc.)State and/or local taxesReal estate taxesMedical & dental expensesContributions to a retirement planStudent loan interestExpenses for higher educationExpenses related to child or dependent carePaid alimony for a divorce executed on or before 12/31/2018Business use of home (not related to W-2 employment)Contributions to Health Savings Account (HSA) or Medical Savings Account (MSA)Contributions to Education Savings Account (ESA) or Qualified Tuition Program (QTP)Home services (housekeeper, gardener, caregiver, etc.)Penalty for early withdrawal of savingsArmed Forces moving expensesUnreimbursed work-related expenses as a teacher, Armed Forces reservist, performing artist,fee-based state or local government official, or individual with a disabilityNone of the aboveSelect financial events that occurred in this Tax Year.Bought or sold a home (including a rental property)Refinanced home or took out a second mortgageMade energy-efficient improvements to home (e.g. air conditioning, furnace, water heater, insulation)Received or exercised stock optionsMade a major purchase of a car, boat, motorhome, airplane, etc.Made gifts of more than $15,000 to one or more individualsReceived forgiveness of debt or forgave debt owed to youReceived, sold, sent, exchanged, or otherwise acquired virtual currencyHad foreign activities, income, savings, investments, trust, or business interestsHad a financial interest in or signature authority over a foreign financial accountConverted or rolled over IRA or other qualified plan (401(k), 403(b), etc.) to Roth IRAIncurred property damage or theft caused by a federally declared disasterHad foreign bank accounts that have in aggregate $10,000 or moreDid NOT have health insurance coverage for the entire year (CA, DC, MA, NJ, and RI only)Purchased health insurance through the Marketplace or public exchange (Form 1095-A)None of the aboveWould you like to file your tax return electronically? *YesNoWould you like to use a bank account to do any of the following?Electronic direct deposit of refundElectronic payment of tax due when the return is filedElectronic payment of tax due when an extension is filedElectronic payment of quarterly estimated taxesAccount InformationFinancial Institution *Routing NumberAccount Holder name *Account No. *--Select-- *Account TypeCheckingSavingsPersonalBusinessIRANon- USState ID Front and Back (You can add multiple files) *Choose FileNo file chosenDelete uploaded fileTax Documents (You can add multiple files) *Choose FileNo file chosenDelete uploaded fileSend Message
