Clients with Dependents (If you are a new client or are adding a new dependent, we will need a copy of the social security card.)
Name of Dependent
Date of Birth
Relationship to you
# of months lived in your home
Is Dependent US Citizen
Single or Married
Full Time Student
Disabled
Can anyone else claim Dependent
*If full time college student, include tuition statement (1098T). Were education credits claimed in the past? Yes/No If yes, how many years____
*If you have daycare expenses, provide statement with the provider name, address, phone #, SSN or EIN & the amount paid for the year.
* If relationship is other than son or daughter please answer the following questions.
-If biological parents are not living with the child where are the parents? Dad _____________________Mom __________________
- Can you provide documentation (birth certificate/marriage certificate) to prove your relationship to the child? Yes/No
- Did you make more money than the parent(s) of the child? Yes/No
* If asked could you provide IRS with any of the following showing proof the child lived at your address? Yes/No
- If yes, check those that apply to you. School records _____ Medical records _____ Social Services _____ Daycare records _____