Full Name

Tax Year

Preparer Name

YOUR INFORMATION & RELATIONSHIPS

Filing Status

Did you live with any children or dependents during the tax year?

Name(s) & Age(s):
Months lived with you:

Did anyone else provide financial support for your household or dependents?

Who?
Amount/Type of support:

Are all dependents listed on this return legally yours to claim?

Yes
No, If No, explain:

INCOME INFORMATION

List all sources of income for yourself and spouse:

W-2s:
1099s (Misc/NEC/Dividends):
Schedule C Business Income:
Other

For Schedule C or self-employment income: Do you have complete records of income & expenses?

Yes

No

Attach receipts, logbooks, invoices, or bank statements.

Any significant changes in income compared to prior years?

If Yes, explain:
No

HEAD OF HOUSEHOLD (HOH) ELIGIBILITY

Did you pay more than half of the household expenses?

Yes

No

Are you supporting a qualifying dependent?

Yes

No

Do you have proof of residency & expenses (rent/mortgage, utilities, bills)?

Yes

No

AMERICAN OPPORTUNITY TAX CREDIT (AOTC)

Did you, your spouse, or dependents attend college or higher education in the tax year?

Yes

No

Attach Form 1098-T and proof of enrolment.

Did you pay qualified education expenses?

Yes

No

Attach receipts or proof of payment

DOCUMENTATION CHECKLIST

For all claimed credits and deductions, please attach:

Birth certificates / adoption records

School letters / enrolment verification

Lease agreements / utility bills

Medical or daycare records

Business logs, receipts, invoices

1098-T / tuition receipts

I certify that the information provided is accurate to the best of my knowledge and that I have provided all supporting documentation requested.

Client Signature

Clear

Client Signature Date