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First Name:

Last Name:

Middle Initial:

Street Address:

Apartment/Unit:

City:

State:

Zip Code:

Phone:

Email:

Did you receive the third stimulus check?

If yes, how much?

Did you receive the monthly child tax credit advance?

If yes, how much?

Do you have health insurance through Obama Care? (If yes, you must submit tax form 1095-A.)

Do you own a business? (If yes, please fill out requested information below.)

Business Name:

Job Title:

Responslbilitles:

From:

To:

Does your business have an EIN?

If yes, provide the number below, EIN:

I certify that my answers are true and complete to the best of my knowledge.

I understand that false or misleading Information may delay my return.

NEED ANY HELP AT YOUR TAX SOLUTION?

Ruston, Louisiana, United States

(318) 243-9537

traylorkarrington@gmail.com

atraylor59@gmail.com