Connect With Caroline and Share Your Goals Today Have questions about financial planning services? Reach out to Caroline "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.1. Personal Information Taxpayer (Primary Contact)Full Name*Date of Birth Phone (Cell)*Phone (Home)Email* Mailing Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code OccupationEmployerSpouse (if Applicable)Full Name*Date of Birth Phone (Cell)Phone (Home)Email* Mailing Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code OccupationEmployer2. Filing Status (Check One) Single Married Filing Jointly Married Filing Separately Head of Household Qualifying Surviving Spouse If your situation changed during the year, please explain3. Dependents List anyone who lived with you and whom you supported.Name First Last Date of Birth RelationshipName First Last Date of Birth RelationshipName First Last Date of Birth RelationshipName First Last Date of Birth RelationshipName First Last Date of Birth RelationshipName First Last Date of Birth Relationship4. Financial InformationBank NameAccount Type Checking Savings Routing NumberAccount NumberFor direct deposit of refund. Did you receive an Economic Impact Payment in 2026? Yes No If yes, total amount received: $5. Income - Please Provide Copies of All That Apply W-2 (Wages from all employers) 1099-NEC (Nonemployee Compensation) 1099-MISC (Other Income) 1099-INT (Interest Income) 1099-DIV (Dividend Income) 1099-B (Sale of Stocks, Bonds, or Other Assets) 1099-R (Pensions, Annuities, Distributions) Unemployment Benefits (1099-G) Alimony Received Social Security Benefits (SSA-1099) K-1 (Partnership, S Corporation, Trust, Estate) Rental Income - Include address & expenses Self-Employment Income Business Income (Schedule C) Farm Income (Schedule F Other Income (state any) *6. Deductions & Credits - Please Provide Copies Mortgage Interest (Form 1098) Real Estate Taxes (Property Taxes) Charitable Contributions (cash & non-cash) Medical & Dental Expenses State & Local Taxes (SALT) Student Loan Interest (Form 1098-E) Tuition (Form 1098-T) Child Care Expenses & Provider Information Energy Efficient Home Improvements (Form 5695) Other Deductions/Credits (list below) *7. Other Information - Please Check All That Apply I own or have an interest in a business I sold or purchased a home I received, sold, or traded cryptocurrency I have foreign bank accounts or assets I paid alimony I was a victim of identity theft I want direct deposit of my refund Other (please explain) *8. Additional Notes or QuestionsAuthorization & Acknowledgment I authorize Caroline LeVere Consulting to prepare my tax return and e-file on my behalf. I have provided all income and expense information to the best of my knowledge. I understand that I should retain all should retain all records in case of an IRS inquiry.SignatureYour NameYour NameYour NameYour NameDate
