Client Information Form Email Address* Filling Status Head of HouseholdMarried Filling JointMarried Filling SeparateSingle Social Security Number First Name Middle Name Last Name Date Of Birth Driving License Occupation Are you active duty in any of the armed forces? YesNo Phone Number Home Address City ZIP Code Spouse information (if Applicable) Social Security number First Name Middle Name Last Name Date Of Birth Driving License Occupation Dependent No 1 Name Date Of Birth Social Security number Relationship Can Anyone Else Claim Months in Home Child Care Expenses Dependent No 2 Name Date Of Birth Social Security number Relationship Can Anyone Else Claim Months in Home Child Care Expenses Dependent No 3 Name Date Of Birth Social Security number Relationship Can Anyone Else Claim Months in Home Child Care Expenses Dependent No 4 Name Date Of Birth Social Security number Relationship Can Anyone Else Claim Months in Home Child Care Expenses Employment Info Tax Payer Employer Occupation Self Employed YesNo Tax Payer Employer Occupation Self Employed YesNo Upload Document TaxPayer Signature Upload Spouse Signature
