Part 1: Taxpayer Information

Filing Status *

Full Legal Name *

Social Security Number/ITIN

Email *

Date of birth *

Phone # *

Full Address (Street#, Unit#, City, State, ZipCode) *

Spouse Info (Skip if Single)

Full Legal Name
D.O.B (mm.dd.yyyy)
SSN

Number of dependents *

Attach your Photo ID (Upload your Spouse's as well if applicable)

Driver's License/Passport/State ID card

PDF, JPEG, JPG or PNG

Attach any tax documents you have

W2, 1099, 1095A, 1098T, etc.....

PDF, JPEG, JPG or PNG

Part 2: Dependents

*SKIP THIS PART IF YOU DON'T HAVE ANY*

Dependent #1

Full Legal Name
SSN
D.O.B (mm.dd.yyyy)

Relationship to Dependent #1

Months in home dep #1

Dependent #2

Full Legal Name
SSN
D.O.B (mm.dd.yyyy)

Relationship to Dependent #2

Months in home dep #2

Dependent #3

Full Legal Name
SSN
D.O.B (mm.dd.yyyy)

Relationship to Dependent #3

Months in home dep #3

Attach photo ID and tax documents for all dependents (SSN card is acceptable)

Attach photo ID for all dependents (SSN card is acceptable)

PDF, JPEG, JPG or PNG

Client Acknowledgement *

I agree Stockhausen Services Co will not be responsible for any rejections due to information that was falsely provided. any fees that were deducted from bank products that you, as the taxpayer, was not aware of, will need to be addressed to the bank personally. any dependents that were falsely claimed shall be the responsibility of the taxpayer, since they provided such information.