Acevedo Tax Services, Inc.

190-25 Woodhull Ave 2S

Hollis NY 11423

Address_____________________________________________________________________

City______________________________ State_____________ Zip Code ___________­­­­____­­­­­­__

 

   ***Please note: We will not Electronically File your return if you do not have at least one good contact phone.***

Home Phone (__ __ __) __ __ __-__ __ __ __         Business Phone(__ __ __) __ __ __-__ __ __ __

Cell Phone    (__ __ __) __ __ __-__ __ __ __         Other Phone   (__ __ __) __ __ __-__ __ __ __

 

FILING STATUS (CIRCLE ONE):

1=SINGLE                                                                 

2=MARRIED FILING JOINT

3=MARRIED FILING SEPARATE (Must list spouse’s name and Social Security Number above)

    Did you live with your spouse during the year 2004?  Yes or No   If yes, list dates.  from _______to_______

4=HEAD OF HOUSEHOLD

5=QUALIFYING WIDOWER; ENTER THE YEAR YOUR SPOUSE DIED ______

 

LIST YOUR DEPENDENTS –(Don’t list spouse here, list at top only.)

Full Name

Birth date

MM/DD/YY

Social Security # –(cannot e-file without it)

Relationship

Months in the home in 2004

Total Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there a possibility that someone else may claim one of your dependents?                       YES_____        NO____

 

Do you want to apply for a refund anticipation loan (RAL- 2 days) or a refund transfer

(RT-2 weeks)?  (Circle either RAL or RT if applicable. Fees are taken out of refund.)         YES_____        NO____

 

Do you want to apply for an “Instant RAL” or an “Instant RT”? (up to $700 cash today!)     YES_____        NO____

 

Do you want to donate $3.00 of any tax you pay to the Presidential Fund?                                          YES_____        NO____

 

Did you receive an Advance Child Tax Credit Check from the IRS?  YES____  NO____    AMOUNT?___________

 

NAME AND PHONE NUMBER OF CLOSEST RELATIVE NOT LIVING WITH YOU:

 

 

NAME_______________________________PHONE#_________________RELATIONSHIP______________

 

 

Text Box: PLEASE HAVE TWO FORMS OF ID READY.  ONE MUST HAVE A PICTURE.

TAXPAYER

 

SPOUSE

First Name

Middle Name

Last Name

SSN

Date of Birth

Occupation

 

First Name

Middle Name

Last Name

SSN

Date of Birth

Occupation