Contact us Today! PleaseFill Out Form Below: Name Phone # Alt Phone # Email Taxpayer job Spouse job SSN DOB Spouse Spouse DOB Address City State Zip Filing status Single Head of household Married filing jointly Married filing separately Notice of noncompliance Dependent Name #1 DOB SSN Dependent Name #2 DOB SSN Dependent Name #3 DOB SSN Dependent Name #4 DOB SSN W-2 income Yes No Rental income Yes No Unemployment Yes No Gambling winnings Yes No Pension/IRA Yes No School expenses Yes No Interest/dividends Yes No Social security Yes No Other incomes Yes No Are you self employed? Yes No Business name Total gross income Advertising Car/truck Utilities Phone # Office Internet/cable Rent/lease Travel Supplies Taxes/licenses Did everyone in your household have health coverage for the entire year? Yes No Did you purchase health care from the marketplace? Yes No Do you have an exemption? Yes No Do you have an exemption? Yes No If yes what's the expectation # Did you have child care expenses? Yes No Monthly amount Message Provider name Phone # Address City ZIP Current payment Time at address Landlord name & address Previous payment Time at address Landlord name & address ATT Send
