Simply Print & fill out the form. Fax it to (843) 851-8610

Name:_______________________SSN:______________DOB:___________

Spouse:______________________SSN:______________DOB:___________

Children/Dependents

Name:_______________________SSN:______________DOB:___________

Relationship__________________                                                                     

Name:_______________________SSN:______________DOB:___________

Relationship__________________                                                                     

Name:_______________________SSN:______________DOB:___________

Relationship__________________                                                                     

EARNINGS

WAGES/SALARIES                                (FAX COPY OF ALL W2'S)

INDEPENDANT CONTRACTORS            (FAX COPY OF ALL 1099'S)

OUT OF WORK?              (FAX COPY OF UNEMPLOYMENT 1099G)

REPORTABLE TIPS: $________________                                      

CASH PAYMENTS:  $_________________                                    

DIVIDENDS/INTEREST: $______________                                    

GAMBLING: $_______________                                                    OUTLAYS

OWN A HOME?                     (FAX COPY OF ALL 1098INT FORMS)

DAY CARE              (FAX COPY OF YEAR END STATEMENT FROM PROVIDER) 

CHARITABLE CONTRIBUTIONS

How much? __________________ to Whom?________________________________

How much? __________________ to Whom?________________________________

How much? __________________ to Whom?________________________________

How much? __________________ to Whom?________________________________

NON CASH (CLOTHES/FURNITURE ETC.)

How much? __________________ to Whom?________________________________

How much? __________________ to Whom?_________________________________

MEDICAL EXPENSES

Hospital: $___________________________                                                         

Doctor: $_____________________________                                                         

Prescription Medicine: $________________                                                         

Does your State have Personal Property Tax?  $__________________________    

Did you Move?   Yes_____ (We will call you)                                                         

Change Jobs?     Yes_____ (We will call you)                                                        

Make any improvements to your Home?  Yes_____ (We will call you)                   

Anyone pursure Higher Education?  Yes_________ (You guessed it, We will call)

Please Fax all requested information to (843) 851-8610. We will call you to go over your income tax return when we complete it, normally within 48 hours. This ensures we have all the information required to accurately complete your return & get you the largest refund possible.