Taxpayer Data Input Form

Please fill out all the forms

Taxpayer

1st Name*Last Name*

Social Security #*Date of Birth*

Home Address*

Apt #City*State*

Zip*Job Title

Phone*Email*

Spouse (if applicable)

Spouse 1st NameLast Name

Social Security #Date of Birth

Spouse Job Title

Please answer the following

Do you have creditable health insurance? Yes No

Will you (taxpayer) be claimed as a dependent on someone else's return? Yes No

Will your spouse be claimed as a dependent on someone else's return? Yes No

2025 Filing Status (tick one)*

Spouse date of death (if widow/er)

Dependent Information

Dependents save you tax dollars! Bring copies of dependents' Social Security cards and proof of health insurance. If dependents are not your kids, be prepared to show proof that you have the right to claim them.

Dependent (First, Initial, Last)	D.O.B	Social Security #	Relationship	Months in home

Childcare Information

Provider's Name and AddressNumber of children in day care

Identification and Questions

DL / ID numberMatricula Consular (if any)

Did you pay tuition last year? Yes No

If yes, how much in fees and tuition (do not include board)? $

Credit you wish to apply for American Opportunity Lifetime Learning

Do you have unreimbursed employee expenses? (Verification needed) Yes No

Do you have a home and paid interest? Yes No

Do you pay taxes on your home? Yes No

Did you make charitable contributions exceeding $500 in cash? Yes No

Alimony paid toAlimony recipient Social Security #

Are you itemizing and filling out Schedule A? Yes No

Did you receive unemployment? Yes No

Do you have a 1099-G? Yes No

Do you have gambling winnings? Yes No

Did you get a W-2G / are you filing 1099-MISC? Yes No

Do you have scholarship income with no W-2? Yes No

Do you have household employee income with no W-2? Yes No

Who was your employer, if you answered yes?

Do you have moving expenses? Yes No

If so, how much? $

Do you have hobby income or hobby related expenses? Yes No

Are you self-employed and filing Schedule C? Yes No

Summarize your Schedule C expenses (proper substantiation is needed for all deductions; copies are kept on file) Anything else we should know?

Declaration, Attestation and Warning

Declaration: I/We have reviewed the information given on this form and, to the best of my/our knowledge, it is true, correct, complete and ready for preparation of my income tax return. I acknowledge that I have maintained adequate documentation to substantiate all deductions that I have claimed.

Warning: It is a felony to file a fraudulent return. Your return is based on the information you provide. We may ask you to substantiate some of it, for example copies of SS cards, W-2s and credits. We do not audit your return, but the IRS will need proof of everything you claim. Do not give your tax information to anybody else but your tax preparer, and check your return carefully before signing.

I have read and understood the declaration and warning above, and I agree that typing my name below is my signature.

Taxpayer signature (type full name)*Date*

Spouse signature (type full name)Date

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Your details go to GWIZA Tax Consultants by email. Email is not fully secure, so if you prefer, call 832-917-2443 and give sensitive numbers in person.