JM Financial Solutions

What was the amount of your return last year after fees?

First Name:

Last Name:

Date of Birth:

Social Security Number

Email:

Cell Phone Number:

Home Phone Number:

Work Phone Number:

Address:

City

State

Zip Code

PIN Number

Drivers License Number:

Issue Date:

Expiration Date

Did the taxpayer or spouse receive form 1095-A?

YES

NO

At any time during 2023, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)?

YES

NO

What is your Filing Status?

Single

Head of Household (Can click this ONLY if you are claiming dependents)

Married Filing Joint

Married Filing Single

Income: Check ALL that apply

W-2

Self Employed

1099

House Hold Income

SELF EMPLOYED: (if you checked self employed, Please answer the following.) Job Description, Months on the job, Amount made on the job, EIN Number and DBA Name

Check here if you do not have the EIN Number

I don't have an EIN Number

I have an EIN and will give it to you later.

SELF EMPLOYED: (if you checked self employed, Please answer the following.) Job Description, Months on the job, Amount made on the job, EIN Number and DBA Name

Check here if you do not have the EIN Number

I don't have an EIN Number

I have an EIN and will give it to you later.

SELF EMPLOYED: Do you need to add another Job?

Yes

No

HOUSEHOLD INCOME: If you checked household income, Please answer the following) Job Description, Name of person you did work for, Phone Number, Address, Amount Made. *THIS CAN NOT EXCEED $2,000

HOUSEHOLD INCOME: Do you need to add another income?

Yes

No

EDUCATION: If you was enrolled in school this year, Please answer the following.) College Name, Address, Total amount you spent on school supplies, Did you attend college more than half of the year? Do you have a 1098 form?

DEPENDENTS: Please answer the following: Dependent 1 Name

Date of Birth

Social Security Number:

Relationship

Is the dependent 1 Disabled?:

Yes

No

Do you PROVIDE more than 50% support for dependent 1?:

Yes

No

Has this dependent lived with you more than half of the year?

Yes

No

Is anyone else claiming the child or allowed to claim the child?:

Yes

No

If yes, Explain if anyone else is allowed to claim the child .

DEPENDENTS: Please answer the following: Dependent 2 Name

Date of Birth:

Social Security Number:

Relationship:

Is the dependent 2 Disabled?:

Yes

No

Do you PROVIDE more than 50% support for dependent 2?:

Yes

No

Has this dependent lived with you more than half of the year?

Yes

No

Is anyone else claiming the child or allowed to claim the child?:

Yes

No

If yes, Explain if anyone else is allowed to claim the child .

DEPENDENTS: Please answer the following: Dependent 3 Name

Date of Birth:

Social Security Number:

Relationship:

Is the dependent 3 Disabled?:

Yes

No

Do you PROVIDE more than 50% support for dependent 3?:

Yes

No

Has this dependent lived with you more than half of the year?

Yes

No

Is anyone else claiming the child or allowed to claim the child?:

Yes

No

If yes, Explain if anyone else is allowed to claim the child .

Are you applying for loan advance?

ID Cards

Upload File

W-2

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W-2

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Social Security Card

Upload File

Social Security Card 2

Upload File

Social Security Card 3

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Social Security Card 4

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Birth Certificate

Upload File

Birth Certificate 2:

Upload File

Birth Certificate 3

Upload File

Pay Stubs

Upload File

Pay Stubs 2

Upload File

1099

Upload File

1099

Upload File

Other

Upload File

Other 2

Upload File

Other 3

Upload File

Additional Information:

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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. By checking the box, I give JM Financial Solutions authority to use the information provided by myself the taxpayer, for filing purposes.

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