Tax Form - Lifeline Tax Solutions

Step 1 of 9

11%

Taxpayer

Name*

First Name Last Name

Email*

Occupation*

Filing Information

Do you have a spouse to include in this tax filing?*

Yes

Do you have any dependents to include in this tax filing?*

Yes

Were you divorced or separated during the year?*

Yes

Were there any deaths in the family?*

Yes

Marital Status on 12/31*

Single

Married

Seperated

Widow(er)

Did you move during the year?*

Yes

Previous Address*

Date of Move*

Spouse

Spouse's Name*

First Name Last Name

Does the spouse reside at the same address as the taxpayer?

Yes

Spouse's Address*

Street Address City State ZIP Country

Dependents

Please list all children and other dependents that live in your household.

How Many Dependent Children?*

How Many Other Dependents or People Who Lived With You?*

Dependent Child 1

Child's Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

College Student?*

Yes

Dependent Child 2

Child's Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

College Student?*

Yes

Dependent Child 3

Child's Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

College Student?*

Yes

Dependent Child 4

Child's Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

College Student?*

Yes

Dependent Child 5

Child's Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

College Student?*

Yes

Other Dependent 1

Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

Income*

Other Dependent 2

Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

Income*

Other Dependent 3

Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

Income*

Other Dependent 4

Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

Income*

Other Dependent 5

Full Name*

SSN*

Do you have a ID PIN (Identity Protection Pin)?*

Yes

IP PIN*

Date of Birth*

Months lived in home in tax year*

Relationship to Taxpayer*

Income*

Questions – All Taxpayers

(Provide related statements or other documentation)

“You” refers to both taxpayer and spouse.

Are either you or your spouse legally blind?*

Yes

Unsure

Did you purchase health insurance through a public exchange?*

Yes

Unsure

Will there be any significant changes in income or deductions next year, such as retirement?*

Yes

Unsure

Did you pay anyone for domestic services in your home?*

Yes

Unsure

Did you purchase a new energy-efficient car, truck, or van?*

Yes

Unsure

Are you involved in bankruptcy, foreclosure, repossession, or had any debt (including credit cards) cancelled?*

Yes

Unsure

Did you pay or receive alimony?*

Yes

Unsure

Alimony Amount PAID*

Alimony Amount RECEIVED*

Recipient's SSN*

Date of Divorce or Separation*

Are you a member of the military?*

Yes

Unsure

State of Residency*

Were you a citizen of or lived in a foreign country?*

Yes

Unsure

Foreign County*

Do you own or have financial interest in a foreign bank or financial account?*

Yes

Unsure

Does the balance exceed $50,000?*

Yes

Children & Education

Were any children born or adopted in tax year?*

Yes

Unsure

(Provide statement for other expenses.)

Did you make any contributions to a 529 plan?*

Yes

Unsure

Were any children attending college?*

Yes

Unsure

Year In College*

Paid by You*

Tuition

Student Loan Interest

Books

Enter the amounts for each item paid by the taxpayer.

Paid by Student*

Tuition

Student Loan Interest

Books

Enter the amounts for each item paid by the student.

Did you pay for child or dependent care so you could work or go to school?*

Yes

Unsure

(Add Statement If Needed)

Name of Provider*

EIN or SSN*

Address*

Amount Paid*

Investments

Did you, or will you, contribute any money to an IRA?*

Yes

Unsure

What type of IRA?*

Traditional IRA

Roth IRA

Did you roll over any amounts from a retirement account?*

Yes

Unsure

Did you sell or transfer any stock or sell rental or investment property?*

Yes

Unsure

Did you receive any income from an installment sale?*

Yes

Unsure

Did you have any investments become worthless or were you a victim of investment theft?*

Yes

Unsure

Were you granted, or did you exercise, any employee stock options?*

Yes

Unsure

Did you receive, sell, send, exchange, or otherwise dispose of any financial interest in any virtual currency?*

Yes

Unsure

Deductions

Did you, or do you plan to, contribute money before April 18 to an HSA?*

Yes

Unsure

If yes, please provide details.*

Did you pay any interest on a loan for a boat or RV that has living quarters?*

Yes

Unsure

If yes, please provide details.*

Did you pay sales taxes on a major purchase , such as a vehicle, boat, or home?*

Yes

Unsure

Did you make any charitable contributions?*

Yes

Unsure

If yes, please provide details.*

Business

Did you work from a home office or use your car for business?*

Yes

Unsure

(self-employed individuals)

Did you receive income from a sharing/gig economy activity (e.g. Airbnb, Uber, etc.)?*

Yes

Unsure

Do you own a business or an interest in a partnership, corporation, LLC, farming activities, or other venture?*

Yes

Unsure

Home

Did you purchase or sell a main home during the year?*

Yes

Unsure

If yes we will need additional information, including the closing statement.

If you sold a home, did you claim the First-Time Homebuyer Credit when it was purchased?*

Yes

Unsure

If yes, please provide details.*

Did you refinance a mortgage or take a home equity loan?*

Yes

Unsure

Did you use any mortgage loan proceeds for purposes other than to buy, build, or substantially improve your home?*

Yes

Unsure

Did you make any new energy-efficient improvements to your home?*

Yes

Unsure

If yes, please provide details.*

Estimated Tax Payments

Did you make any estimated tax payment during this year?*

Yes

Unsure

First Installment*

Date Paid

Federal Amount

Date Paid

State Amount

Second Installment*

Date Paid

Federal Amount

Date Paid

State Amount

Third Installment*

Date Paid

Federal Amount

Date Paid

State Amount

Fourth Installment*

Date Paid

Federal Amount

Date Paid

State Amount

Amount applied from overpayment of prior year?*

Date Paid

Federal Amount

Date Paid

State Amount

State Information*

Full-year Resdient

Part-year Resident

Nonresdient

States of residence and dates (if partial year)*

School District*

Do you rent or own your home?*

Rent

Own