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D R TAX SERVICETax Payer Deduction InformationTax Payer Name: ________________________________________________________________Tax Payer Phone # _______________________________________________________________THIS IS FOR TAX YEAR _____________Federal Refund ________________Owe Federal ________________State Refund __________________Owe State __________________Information Needed For Tax PreparationAmountCommentsMedical InsuranceMedical Mileage/ Parking |Medical Bills/Co Payments/PrescriptionsDental Bills/Co PaymentsVision Bills/Co PaymentsReal Estate Taxes/Property TaxesMortgage Insurance PaidMortgage InterestAd Valorem Taxes/Car TagsEmission FeesTithes, Churches & School (Name Of Place)Charity Donations (Name Of Place)Child Care: 13yrs & Under (Name of Place, Address, EIN)Additional Forms Needed: W2/W2G/1099R-RRB/1099SA/1099SSA1099C/1099M/1099G /1098T/ 1098 E / 1095 A, B or C Health CareVerify Bank Account InformationName_____________________________________Routing#__________________________________Account#__________________________________Bank _____________________ Type___________Additional Comments or Questions:XBy signing this form you agree that all information submitted is true and accurate to the best of your knowledge and corresponds with verified documents.?drtaxervice Revised 04/2020 For office use only----TOTAL FEES $____________ ................
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