ABOUT YOUR PERSONAL AND DEPENDENT (S) INFO, ATTACH COPIES


    INFORMATION ABOUT YOUR STIMULUS PAYMENT

    • ALSO KNOWN AS AN ECONOMIC IMPACT PAYMENT (EIP), IF APPLICABLE.
    • YOU MAY HAVE IRS NOTICE 1444 OR OTHER RECORDS SHOWING YOUR EIP AMOUNT (2021 REQUIREMENT)

    ROUTING AND ACCOUNT NUMBERS TO RECEIVE YOUR REFUND BY DIRECT DEPOSIT OR PAY YOUR BALANCE DUE IF YOU CHOOSE



    FINANCIAL DATA – SOURCE OF INCOME

    SELF-EMPLOYED

    Note: The Taxpayer must have recordkeeping of their transaction to be accomplished with IRS requirements, even in case of audits documentation purposes.

    RENTAL INCOME


    RETIREMENT INCOME

    SAVINGS & INVESTMENTS OR DIVIDENDS


    OTHER INCOME & LOSSES


    TAXES


    ITEMIZED OR STANDARD DEDUCTION

    If "Yes":
    Further Information about this topic could checked through Schedule A from www.irs.gov

    Disclaimer

    End to End parties agrees

    Taxpayer Full Name:
     
    Date:
    Spouse Full Name:
     
    Date