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DROP-OFF INFORMATION SHEET DATE: PREPARER REQUESTED ARE YOU NEW TO US? Y NPHONE: EMAIL: NAME(S): SSN: BDATE: SSN: BDATE: FILING STATUS: ______________ OCCUPATION(S) ________________________________ADDRESS: SCHOOL DISTRICT: TWP: DEPENDENTS:1 SSN: BDATE: _RELATIONSHIP: __________ HOW MANY MONTHS DEPENDENT LIVE WITH YOU______2_______________________________ SSN: __________________ BDATE: ______________RELATIONSHIP: ____________HOW MANY MONTHS DEPENDENT LIVE WITH YOU ______3_______________________________ SSN: __________________ BDATE: ______________RELATIONSHIP: _____________HOW MANY MONTHS DEPENDENT LIVE WITH YOU _____BANKING: BANK NAME ROUTING #: ACCOUNT # SAVINGS CHECKIINGSTIMULUS: DID YOUR RECEIVE A STIMULUS CHECK AND AMOUNT? DID YOU PURCHASE HEALTH INSURANCE THROUGH THE ACA? (1095-A)DID YOU RECEIVE UNEMPLOYMENT? ______ (DO YOU HAVE YOUR 1099-G?)DOCUMENTS NEEDEDPHOTO ID W-2’SALL 1099’S 1098-T (COLLEGE STUDENTS) SSN CARDS DAYCARE INFO DEPENDENTS: BIRTH CERT. & PROOF OF RESIDENCY ................
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