On Line Client Worksheet

Online Client Worksheet

Please enter all the information that you have available. If you have any additional information not covered on this worksheet please enter in the Additional Tax Information or Suggestion Box.

Taxpayer:		Spouse:
First Name		First Name
Middle Initial		Middle Initial
Last Name		Last Name
Social Security Number		Social Security Number
Date of Birth		Date of Birth
Occupation		Occupation
Work Number		Work Number
Home Number		Home Number
E-mail Address		E-mail Address
Blind	No Yes	Blind	No Yes
Address
City
State
Zip Code
Tax Rebate 2003	No Yes

Please choose 1 of the 5 Filing Status:

1 Single

2 Married Filing Jointly

3 Married Filing Separately

Check the box if the taxpayer did not live with spouse at any time during the year►

Check this box if client is eligible to claim spouse's exemption ........................►

Check this box if client is a Dual Status Alien..............................................►

4 Head of Household

If the qualifying person is a child but not a dependent,

Child's Name: Child's Social Security Number:

5 Qualifying widow (er)

Check the appropriate box for the year the spouse died................. 2001 2002

Go to Dependent Information	Go to W-2 Information
Go back to Client Information

Did Dependent Live with Taxpayer?

First Name

Last Name

Year of Birth

Dependent's Social Security Number

Relationship

No of Months in Home

Educ Expense









Go to Child and Dependent Care Information					Go to W-2 Information
Go back to Client Information

Name	Street Address	City	State	Zip Code	EIN	Amount Paid






Go to W-2 Information Go to Payment Information
Go back to Client Information


Employer Information:
a - Control no. (if any)
b - Employer ID no.
c - Employer's:
Name
Name (Continue)
Street
City
State
ZIP code

Boxes 1 thru 11:
1 - Wages			2 - Federal Tax W/H
3 - Soc. Sec. Wages			4 - Soc. Sec. Tax W/H
5 - Medicare Wages			6 - Medicare Tax W/H
7 - Soc. Sec. Tips			8 - Allocated Tips
9 - Advance EIC			10 - Dependent Care
11 - Nonqualified Plans

Boxes 12 thru 14:
Box 12 - Letter Code (if any)		Amount



Box 13 - Check any boxes that are checked on your W-2
Retirement Plan
Statutory Employee
Third-Party Sick Pay
Box 14 - Description (if any)		Amount




State and Local Taxes:
Box 15 - State	Employer's State ID No.		Box 16 - State Wages		Box 17 - State Income Tax



Box 18 - Local Wages		Box 19 - Local Income Tax		Box 20 - Locality Name



Add Another W-2			Go to Payment Information
Go back to Client Information


Employer Information:
a - Control no. (if any)
b - Employer ID no.
c - Employer's:
Name
Name (Continue)
Street
City
State
ZIP Code

Boxes 1 thru 11:
1 - Wages			2 - Federal Tax W/H
3 - Soc. Sec. Wages			4 - Soc. Sec. Tax W/H
5 - Medicare Wages			6 - Medicare Tax W/H
7 - Soc. Sec. Tips			8 - Allocated Tips
9 - Advance EIC			10 - Dependent Care
11 - Nonqualified Plans

Boxes 12 thru 14:
Box 12 - Letter Code (if any)		Amount



Box 13 - Check any boxes that are checked on your W-2
Retirement Plan
Statutory Employee
Third-Party Sick Pay
Box 14 - Description (if any)		Amount




State and Local Taxes:
Box 15 - State	Employer's State ID No.		Box 16 - State Wages		Box 17 - State Income Tax



Box 18 - Local Wages		Box 19 - Local Income Tax		Box 20 - Locality Name



Add Another W-2			Go to Payment Information
Go back to Client Information


Employer Information:
a - Control no. (if any)
b - Employer ID no.
c - Employer's:
Name
Name (Continue)
Street
City
State
ZIP Code

Boxes 1 thru 11:
1 - Wages			2 - Federal Tax W/H
3 - Soc. Sec. Wages			4 - Soc. Sec. Tax W/H
5 - Medicare Wages			6 - Medicare Tax W/H
7 - Soc. Sec. Tips			8 - Allocated Tips
9 - Advance EIC			10 - Dependent Care
11 - Nonqualified Plans

Boxes 12 thru 14:
Box 12 - Letter Code (if any)		Amount



Box 13 - Check any boxes that are checked on your W-2
Retirement Plan
Statutory Employee
Third-Party Sick Pay
Box 14 - Description (if any)		Amount




State and Local Taxes:
Box 15 - State	Employer's State ID No.		Box 16 - State Wages		Box 17 - State Income Tax



Box 18 - Local Wages		Box 19 - Local Income Tax		Box 20 - Locality Name



Add Another W-2			Go to Payment Information
Go back to Client Information


Employer Information:
a - Control no. (if any)
b - Employer ID no.
c - Employer's:
Name
Name (Continue)
Street
City
State
ZIP Code

Boxes 1 thru 11:
1 - Wages			2 - Federal Tax W/H
3 - Soc. Sec. Wages			4 - Soc. Sec. Tax W/H
5 - Medicare Wages			6 - Medicare Tax W/H
7 - Soc. Sec. Tips			8 - Allocated Tips
9 - Advance EIC			10 - Dependent Care
11 - Nonqualified Plans

Boxes 12 thru 14:
Box 12 - Letter Code (if any)		Amount



Box 13 - Check any boxes that are checked on your W-2
Retirement Plan
Statutory Employee
Third-Party Sick Pay
Box 14 - Description (if any)		Amount




State and Local Taxes:
Box 15 - State	Employer's State ID No.		Box 16 - State Wages		Box 17 - State Income Tax



Box 18 - Local Wages		Box 19 - Local Income Tax		Box 20 - Locality Name



Go to Payment Information			Go back to Client Information

Payment Type:
Credit Card Type:
Credit Card Number:
Expiration Date:	/ (MM/YY)
Card ID:
***Required for American Express, Visa, or Master Card
Go to Account Information		Go back to Client Information

0101
Memo___________________ _______________________
Ι: 123456789 Ι: 0101 ▪▪Ι 56789 ▪▪Ι 56789 ΙΙ▪

↕ ↕ ↕

Routing/Transit Check Checking Account
(A 9-digit No.) Number

Bank Name		City
State
Routing/Transit Number:
Checking Savings Other
Account Number:

Go back to Client Information

Add any Additional Information or Suggestions

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Online Client Worksheet

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Send mail to Webmaster@IT-PSS.COM with questions or comments about this web site. Last modified: 09/15/07

Send mail to Webmaster@IT-PSS.COM with questions or comments about this web site.
Last modified: 09/15/07