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Client Registration Form

Multi-line address
Date of Birth
Month
Day
Year
What is your filing status?

If you chose Married Filing Joint or Separated, Please Enter Spouse Full Name and Date of Birth

Spouse Date of Birth
Month
Day
Year
Will you be claiming children or dependents?
Yes
No
Child/Dependents Date of Birth (if applicable)
Month
Day
Year
Child/Dependents Gender
2nd Child/Dependents Date of Birth (if applicable)
Month
Day
Year
2nd Child/Dependents Gender
3rd Child/Dependents Date of Birth (if applicable)
Month
Day
Year
3rd Child/Dependents Gender
Do you pay for child care?
Yes
No
Do you own a home or pay a mortgage (Form 1098)?
Yes
No
Did you attend college this year (Form 1098T)?
Yes
No
Did you purchase Health Insurance through the “Health Marketplace”?
Yes
No
Did you receive a 1095-A Medical Tax Form?
Yes
No
Checking or Savings?
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