Client Information

**Annual Client Update is IRS Mandated**

Received Date: Click or tap to enter a date. ☐ New Client ☐ Last Yr Return Choose an item.	Tax Year: Click or tap to enter a date.

Last Name Click or tap here to enter text.	First Name, MI Click or tap here to enter text.	Social Security # Click or tap here to enter text.	Date of Birth Click or tap to enter a date.
Driver’s License Information ☐ N/A	State & Number Click or tap here to enter text.	Issue date Click or tap to enter a date.	Expiration Date Click or tap to enter a date.
Mobile Phone Click or tap here to enter text.	Home Phone Click or tap here to enter text.	Email Click or tap here to enter text.
Spouse Last Name Click or tap here to enter text.	First Name, MI Click or tap here to enter text.	Social Security # Click or tap here to enter text.	Date of Birth Click or tap to enter a date.
Driver’s License Information ☐ N/A	State & Number Click or tap here to enter text.	Issue date Click or tap to enter a date.	Expiration Date Click or tap to enter a date.
Mobile Phone Click or tap here to enter text.	Home Phone Click or tap here to enter text.	Email Click or tap here to enter text.
Address Click or tap here to enter text.
City Click or tap here to enter text.	State Click or tap here to enter text.	Zip Click or tap here to enter text.

Filing Status Choose an item.	Direct Deposit Information Bank: Click or tap here to enter text. Rtg: Click or tap here to enter text. Acct: Click or tap here to enter text. Client initials
Client copies Choose an item.
Client Data: ☐ Req review prior to filing (for large returns) ☐ Return originals to client ☐ Pick Up ☐ Mail - $10 Fee ☐ Destroy Originals ☐ I understand that Taxico Financial will not keep my original documents. Upon 31 days from contact date that file is complete, my originals will be destroyed following IRS mandates for destruction of personal documentation. If this box is left unchecked, I will not receive my original documents back and they will be destroyed following IRS mandates of destruction of personal documents

**	Dependent First Name	MI	Dependent Last Name	Social Security #	Date of Birth	Relationship
1 ☐	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.	Choose an item.
2 ☐	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.	Choose an item.
3 ☐	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap to enter a date.	Choose an item.

**New client dependent documentation included. (ie birth certificate and social security card)

I certify that I have reviewed the information above, and it is correct to the best of my knowledge.

Client Signature Date