PRIMO Income Tax
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Primo Tax Client Data Form
PRIMO Income Tax occasionally have products or services that we think may be of interest to you. By checking this box and submitting this form, may give us consent to use submitted technology to call and text you at the phone number (s) above, including your spouse's number if provided. Please note that you are not required to provide this consent to make a purchase from us.
DEPENDENTS NAME:
MONTH, DAY & YEAR
DEPENDENTS SSN
RELATIONSHIP TO YOUR
MONTHS LIVED IN YOUR HOME
Months
1
2
3
4
5
6
7
8
9
10
11
12
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Months
12
11
10
9
8
7
5
6
4
3
2
1
Item 9
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Months
12
11
10
9
8
7
6
5
4
3
2
1
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Months
12
11
10
9
8
7
6
5
4
3
2
1
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CHECK ALL THAT APPLY
You and, if applicable all your qualifying dependents have medical insurance for the entire year ( 1st-Dec 31st)
Someone else can claim you as a dependent.
You and your spouse lived apart during the year and did you live together at any time after June 30
You paid estimated Federal or State taxes last year
You Itemized last year.
You and spouse were resident of another state or earned income in another state
You purchased a home in 2008 and received the up to $7,500 First-time Home Buyer credit
You were a student, had education expenses, or made student loan payments. If yes fil out the School Expenses Data Sheet
HOW WOULD YOU LIKE TO RECEIVE YOUR REFUND
Deposited into my bank Account from the IRS
Deposited into my bank account using bank product .
Receive my refund check in the mail from the IRS
I am not receiving a refund check
Checkings
Savings
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Are you self employed? If yes, please fill out the Self Employed Income and Expenses Data Sheet
YES
NO
CHECK ALL FORMS THAT APPLY
Wage Statements - W2s
1099s
Tips / Other Income
Received Interest
Received Dividends
Sold Stocks or Bonds
Pensions or Retirements
IRAs
Received Unemployment
Alimony (Paid or Received)
Buy or Sell a Home
Own Rental Property
Mortgage Interest
Mortgage Points (closing)
Paid Real Estate Taxes
Property Tax
Farm Income
Medical Expenses
Lottery Gambling Winnings
Cancellation of Debt
Charity Contributions
Significant Loss or Theft
CHILD CARE INFORMATION
UPLOAD FILES
Please upload Source of Income W2's or 1099-Misc, Including your SS#/ITIN and picture ID.
Dependents copy of SS#/ITIN and proof of residency
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I CERTIFY THAT I WOULD LIKE MY TAXES PREPARED ACCORDING TO THE INFORMATION I SUPPLIED ABOVE.
BY SELECTING THIS OPTION, I AGREED TO USE MY NAME AND DATE AS ORIGINAL SIGNATURE.
TaxPayer's Signature
Clear
Today's Date
Spouse's Signature
Clear
Today's Date
SUBMIT FORM
