Name: __________________________  Birth Date___________

Phone______________

O -I agree to receive communications by text message for picking up tax returns from Seitz Financial Services. You may opt out by replying STOP or ask for more information by replying HELP. Message frequency varies. Message and data rates may apply. You may review our Privacy Policy https://www.seitz-financial.com/privacypolicy to learn how your data is used.

Spouse:_________________________  Birth Date___________

Phone_______________

O -I agree to receive communications by text message for picking up tax returns from Seitz Financial Services. You may opt out by replying STOP or ask for more information by replying HELP. Message frequency varies. Message and data rates may apply. You may review our Privacy Policy https://www.seitz-financial.com/privacypolicy to learn how your data is used.

Address ________________________________________________

City _____________________ State _______________  Zip________________

1.      What is your driver’s license number? _________________   State license issued: _____  

A.        Issue Date:________________     Expiration Date:_________________

2.      Did you move in 2023? ______ If yes:

a)      Date moved: ___________       b) Old address: ________________________

c)      New address: ______________________________________

3.      2023 Occupation: _________________ If MFJ/MFS spouse occupation: ______________

4.      What is your marital status at the end of 2023? (Circle One)           Married             Single

5.      Do you want direct deposit if receiving a return? (Circle One)       Yes       No

A.      If yes, fill out attached worksheet with DD information or attach canceled check.

6.      Are you a full-time teacher who had $300.00 in non-reimbursed school supplies OR did you have homeschooled expenses for a dependent up to $300.00? ($600.00 for MFJ if both spouses teach.) See attached worksheet for details.     (Circle One)       Yes          No

7.      At any time during 2023 did you (a) receive (as a reward, award, or compensation); or (b) sell, exchange, gift, or otherwise dispose of a digital asset (or financial interest in a digital asset)?    (Circle One)               Yes                No

8.      Are you paying off student loans and if so, did you receive a 1098-E form?      Yes         No

9.      Did you contribute or withdraw from ANY IRA’s at all this year? If so, do you have a 1099 for it?                            Yes                   No

10.  Did you purchase insurance from the Marketplace and receive a 1095-A? Yes       No

11.  Can you be claimed as a dependent on anyone else’s tax return?         Yes             No