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Kenneth D.
Janika M.
Daniece J.
Jacqueline T.
Abdul K.
Tabitha P.
Ashley W.
Sakiyna M.
Jennifer P.
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Selna M.
Brittany B
Tamisha C.
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Taxpayer Information:

First Name *

Last Name *

Phone *

Email *

Date of birth *

Filing Status *

Single
Head of Household
Married Filing Joint
Married Filing Separate
Qualifying Surviving Spouse
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Taxpayer SSN *

IP PIN *

If you hav an IP PIN please provide it here. If you do not have one just put N/A.

Upload Taxpayer Social Security Card

Identification number *

Upload Identification *

Address *

Street Address

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal Code

What is your Occupation? *

Spouse Information:

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Phone Number

Spouse SSN

Spouse Date of Birth

Spouse Identification Number

Upload Spouse Identification

Did you Have "Market Place" Insurance? *

Yes
No
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In tax year 2025 did your receive form 1095A from the IRS?

If "YES" Please upload the form here.

Spouse Occupation

Spouse Address

Spouse City

Spouse State

Spouse Country

Spouse Zip Code

Dependent Information

Dependent #1:

Dependent 1 First Name

Dependent 1 Last Name

Dependent 1 SSN

Dep 1 Date of Birth

Dep 1 Relationship

Son
Daughter
Grand Child
Nephew
Niece
Brother
Sister
Foster Child
Step Brother
Step Sister
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Dependent #2:

Dependent 2 First Name

Dependent 2 Last Name

Dependent 2 SSN

Dep 2 Date of Birth

Dep 2 Relationship

Son
Daughter
Grand Child
Niece
Nephew
Sister
Brother
Foster Child
Step Brother
Step Sister
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Dependent #3:

Dependent 3 First Name

Dependent 3 Last Name

Dependent 3 SSN

Dep 3 Date of Birth

Dep 3 Relationship

Son
Daughter
Grand Child
Niece
Nephew
Sister
Brother
Foster Child
Step Brother
Step Sister
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Dependent #4:

Dependent 4 First Name

Dependent 4 Last Name

Dependent 4 SSN

Dep 4 Date of Birth

Dep 4 Relationship

Son
Daughter
Grand Child
Nephew
Niece
Brother
Sister
Foster Child
Step Brother
Step Sister
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Dependent #5:

Dependent 5 First Name

Dependent 5 Last Name

Dependent 5 SSN

Dep 5 Date of Birth

Dep 5 Relationship

Son
Daughter
Grand Child
Nephew
Niece
Brother
Sister
Foster Child
Step Brother
Step Sister
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Do you have any expenses for childcare? *

Yes
No
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Upload Dep Documents *

Make sure its clear with all 4 corners in picture/scan SSC & Birth Certificate for each dependent

Dependent Additional Documents *

Report Card, Medical Card, Day Care Forms

Tax Questions

Did you receive unemployment last year? *

Yes
No
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Did you (taxpayer) or a dependent receive disability income?

Yes
No
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Did you receive a federal tax return last year?

Yes
No
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Did you receive a state tax return last year? *

Yes
No
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Did you have Business income *

Yes
No
NOT SURE
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Please Upload all tax document and business income documents *

Upload W2's, 1099's, All Business Documents, lease or mortgage statement

Bank Account Information:

Bank Name *

Routing Number *

Account Number *

Account Type: *

Checking
Savings
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Acknowledgement & Signature

I confirmed that all information I entered here is accurate and true. 
I allow Established/210 TAX to capture my sensitive data like personal id, government id, social security number (SSN), and other information.  
I acknowledge that all information provided to Established Tax LLC/210 Tax is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to; facing court dates, restitution and possible imprisonment. I waive Established/210 Tax LLC and the preparer of any error due to incorrect information provided by me. By signing below, I authorize Established Tax LLC to file my tax return.

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mm/dd/yyyy

Taxpayer Signature *

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