Interview Sheet

Licensed Stores Available!
Own your own Liquid Tax Retail Store

Address: PO Box 2606 Suwanee, GA 30024
Contact: 888-541-4443
Fax: 877-531-9128

Tax Interview Sheet

Please fill out correctly to ensure a quick refund! Check the spelling of all names, make sure the birth date and Social Security numbers are correct. Bring in all W-2’s and 1099’s.

Taxpayer Information

Social Security Number

First Name:		Filling Status:
Last Name:		Spouse Name:
Birth Date:		Spouse SSN:
Address:		Spouse DOB:
City:		Phone:
State:		Zip Code:

Dependent Information

Name	Date of Birth	Social Security #	Relationship

Are any dependents legally handicapped or mentally disabled?

Yes No

Number of W-2’s

Other Incomes (please describe)

Sign:		Date:
Sign:		Date:

I/We certify that the information filled out on this form is true an correct, and I/we understand that the information given on this form will be used to complete my/our tax return(s). I/We agree to hold Liquid Tax harmless for any errors that they may make on my/our tax return(s). I/We also understand that an error on my/our tax return will cause a delay in the processing of the return and the receipt of the refund, if any.