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CLIENT PROFILE
B4 Financial Solutions
817-683-9557 • brianna@b4financialsolutions.us
W2 Estimates $50 • Business Estimates $100
Please complete all sections and CIRCLE your answer where applicable.
Taxpayer Name
DOB
-
Month
-
Day
Year
Date
SSN
Spouse Name
DOB
-
Month
-
Day
Year
Date
SSN
Address
City/State/Zip
Cell Phone
Format: (000) 000-0000.
Home Phone (Alt. phone required)
Format: (000) 000-0000.
Email Address
example@example.com
Filing Status:
Single
Head of Household
Widow(er)
Married Filing Separate
Married Filing Jointly
Rows
Dependent Name (First then Last)
DOB
Relationship
SSN
Months in Home
1
2
3
Did you, spouse and/or dependent(s) receive SOCIAL SECURITY? Circle: YES / NO
YES
NO
Did you, spouse and/or dependent(s) receive UNEMPLOYMENT? Circle: YES / NO
YES
NO
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Next
Did you, spouse and/or dependent (19-24 years old) attend school for at least 6 months? Circle:
YES
NO
Do you have any debts with the IRS, US Treasury, child support, student loans, FEMA or any govt. entity? Circle:
YES
NO
Do you have health insurance coverage? Circle:
YES
NO
If so, is your health insurance through Marketplace? Circle:
YES
NO
Are you legally married based on your state's definition of marriage? Circle:
YES
NO
Can someone else claim you/spouse as a dependent? Circle:
YES
NO
Did you/spouse receive any kind of military pay earnings? Circle:
YES
NO
Did your EIC qualifying children live with you in the same main home in the US? Circle:
YES
NO
Direct Deposit Information: Routing #
Account #
Security Question: Mother's maiden name
OR Oldest child's name
B4 Financial Solutions will prepare your individual tax return from the information you have provided. We will not audit or verify the information furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. Please review all information carefully before signing.
Taxpayer Signature
Spouse Signature
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