Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Where does the income come from? *

W-2 (employee)

Own business (LLC, S-corp, C-corp etc)

Investment (Stock, Coin etc)

Something else

Spousal name

First Name

Last Name

Do you have dependent? *

Yes

No

You or your dependent are

Legally blind, permanently disabled

Non-resident alien

N/A

Do you have valid insurance during the tax year? *

Such as Covered California, Medicare, individual insurance etc

Yes

No

Do you have expenses?

These costs refer to all amounts spent on you and your dependents.

Tuition fee

Medical contribution or fees

Child care or adoption

Housing or Interest

Something else (donation, alimony, foreign tax, sales tax etc)

N/A

Do you have asset in foreign?

If it is $10,000 or more, please answer 'Yes'.

Yes

No