More Money Tax

Email: 972-352-9900 Office; 954-416-5163 Fax

Client Worksheet 2014

Personal Information

·  Name SSN Birth Date
______

·  Spouse SSN Birth Date
______

·  Dependent(s) SSN Birth Date Relationship
______

·  ______

·  Address Phone E-Mail
______

Income Information

Income From Jobs

·  W-2 / 1099 Amount______

·  Occupation______

Investment Income

·  Interest income - Form 1099-INT ______

·  Dividend income - Form 1099-DIV ______

Home Office or Self-operated business

·  Income from Home Based Activity______Type Of Business______

Office/Job Expenses (Self operated activity, employment, work to generate income)

·  Advertise (Flyers/Business cards etc)______

·  Vehicle /Description/Date in Service/Total Miles/Business Miles______

·  ______

·  Commission and Fees______Rent Expenses______

·  Contract Labor______Repairs & Maintenance______

·  Insurance(Other than health)______Tax and Licenses ______

·  Interests______Travel Expenses ______

·  Legal Services______Meals & Entertainment______

·  Office Expenses ______Utility Expenses______

·  Other Business Expenses ______Employee Wages______

Tuition fees and books______

Home mortgage interest:

·  ______

Charitable Donations

·  ______

Real Estate Taxes

·  ______

Childcare Costs

·  Childcare provider's name and address
______

·  Provider's tax ID or Social Security number
______

Medical Costs, Name Of Provider and Dependents Covered

·  ______

Direct Deposit Information

If you want your tax refund deposited directly into your bank account:

·  Routing number from the lower left side of one of your checks (usually the first nine digits)
______

·  Bank account number from the bottom of the check or on a bank statement
______

Include a copy of your Drivers License and Social Security Card

Sign______Date______

Fax: 954-416-5163

Assumption of Responsibility

To the best of my knowledge and understanding, all the above information is correct as of the date signed. I understand that the information that I provide will be used as qualifying criteria for items to be submitted to the Internal Revenue Service. I assume full responsibility for any errors, or omissions and understand that More Money Tax will Not be held liable for any denials or penalties but will have audit services available.