info@primetymeconsultants.com | 409-923-8148

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Personal Information

Full Name:
Phone:
Email:
Social Security #:
Address
Driver's License #:
Issue Date:
State of Issue:
Expiration Date:
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Filing Status

I'm Filing:
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Income

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Head Of Household / W-2 Income Worksheet

Employer Name:
Employer Phone:
Employer Address:
State:
Job Description:
Income Amount:
Zip:
Upload Your W-2 Here:
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Self-Employed / 1099 Worksheet

Job Description:
EIN # (only if self-employed):
Yearly Total Income:
Months on Job:
Check here if NO EIN:
NO EIN
Upload all Documents Here (1099, PNL sheet, etc.)
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Education

Did you or your dependent attend college this year?
College Name:
Amount Spent on School Supplies:
College Address:
Upload 1098-T (if you received one):
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Dependents

Dep. Full Name:
Social Security #:
Is this dependent disabled?
Did this dependent live with you at least 6 months?
Have you received any advanced child tax credits?
Do you have another dependent?
Date Of Birth:
Relationship to You (the taxpayer):
Did you provide at least 50% support?
Can anyone else claim this dependent?
Please upload all documents for all dependents:
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Dep. Full Name:
Social Security #:
Is this dependent disabled?
Did this dependent live with you at least 6 months?
Have you received any advanced child tax credits?
Do you have another dependent?
Date Of Birth:
Relationship to You (the taxpayer):
Did you provide at least 50% support?
Can anyone else claim this dependent?
Dep. Full Name:
Social Security #:
Is this dependent disabled?
Did this dependent live with you at least 6 months?
Have you received any advanced child tax credits?
Do you have another dependent?
Date Of Birth:
Relationship to You (the taxpayer):
Did you provide at least 50% support?
Can anyone else claim this dependent?
Dep. Full Name:
Social Security #:
Is this dependent disabled?
Did this dependent live with you at least 6 months?
Have you received any advanced child tax credits?
Date Of Birth:
Relationship to You (the taxpayer):
Did you provide at least 50% support?
Can anyone else claim this dependent?
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Due Diligence

Are you married?
What is the name of the non-custodial parent and why is he/she not claiming the dependent?
If you are separated or divorced, when is the last date you lived in the home?
Do you have joint custody? If yes, how many months did the dependent(s) live with the other parent?
Do you have a signed form 8332? (Custodial Parent Release of Claim of Dependent(s) on tax return)
Did anyone else live in the home that provides financial support for your dependent(s)? If so, how much do they pay? If not, just answer "no".
Are your dependent(s) biologically yours?
Are you applying for a loan advance?
Do you or anyone else receive financial aid for dependent(s)?

Refund Receive Type

How would you like to receive your refund?
Bank Account Number:
Bank Name:
Bank Routing Number:
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Document Upload

Upload any other supporting documents here:
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How did you hear about Primetyme Consultants?
Referral Full Name:
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Regarding Qualifying Children for Earned Income Credit

According to the information you provided in regards to the dependent(s), the dependent(s) is/are your biological child, grandchild, niece, or nephew, etc.

I discussed with you a qualifying child cannot be used by more than one person per tax period. One person is one of the parent(s) if married filing jointly.

If filing Head of Household, you attest that you can provide a lease or utility bill in your name at your current address.

Please note: You are stating that you provide over 50% of care and support for the dependent(s), you are the sole provider for the dependent(s), the dependent(s) lives with you for more than half the year, and no one else is eligible to claim the dependent(s).


By signing below, you are stating that the dependent(s) information on your tax return is true, correct, and has been documented by your preparer. You are stating that you are not providing your preparer with any false/fraudulent information.
ANY AND ALL INFORMATION HAS BEEN FILLED OUT BY ME TO THE BEST OF MY KNOWLEDGE. THE DATA FILLED OUT BY ME, (THE TAXPAYER) ,IS ACCURATE AND TRUTHFUL. I give, Schilacy's Tax Service., authority to use the information provided by myself, the taxpayer, for filing purposes. 


I am providing my signature electronically (by mobile phone or computer).  All final paperwork will need your official signature in office OR by Docusign before filing.

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