TAX BY FAX PRINTABLE WORKSHEET

PART I - GENERAL INFORMATION


Simply print out the form below, fill in the information and fax or mail these copies to us. 
Name: ____________________________________        SS#: ___________________
 
Spouse's Name: _________________________________  SS#: ___________________

Home Address:  ___________________________________________________________

Mailing Address (if different): __________________________________________

City: _________________________   State:______________   Zip: ____________


    Presidential Election Campaign: Do you want $3 to go to this fund?

    Taxpayer: YES_______  NO_______      Spouse: YES_______  NO_______


Taxpayer Date of Birth: ____/____/______ Occupation: _____________________

Spouse's Date of Birth: ____/____/______ Occupation: _____________________

Taxpayer Telephone: (____)_____-________ E-mail: _________________________

Can your parents or someone else claim you as a dependent on their return?

               Yes_______  NO_______


  


Dependent Information

First and Last Name       Date of Birth    SS Number    Relationship  Months
                                                                      in home

________________________  ___/____/____  ____-___-_____ _____________  __ __

________________________  ___/____/____  ____-___-_____ _____________  __ __

________________________  ___/____/____  ____-___-_____ _____________  __ __

________________________  ___/____/____  ____-___-_____ _____________  __ __

________________________  ___/____/____  ____-___-_____ _____________  __ __

________________________  ___/____/____  ____-___-_____ _____________  __ __



		FAX:	  802-773-9381
		ADDRESS:  4 Seasons Accounting, LLC
		          Tax By Fax
			  25 Curtis Ave.
			  Rutland, VT 05701

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