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Taxpayer
Taxpayer First Name
Driver License/ID Number
Taxpayer Middle Name
Issue State
Select One...
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District Of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Taxpayer Last Name
Issue Date
Date of Birth
Expiration Date
Social Security Number
Occupation
Filing Status
Filing Status
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualified Surviving Spouse
Number of Dependents
0
1
2
3
4
5
Spouse
Spouse Name
Driver License/ID Number
Spouse Middle Name
Issue State
Select One...
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District Of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Spouse Last Name
Issue Date
Date of Birth
Expiration Date
Social Security Number
Occupation
Cell Phone
Spouse Email
Dependents
Dependent 1
First Name
Social Security Number
Middle Name
Type of Relationship
Select One...
Son
Daughter
Step Child
Half Brother
Half Sister
Stepbrother
Stepsister
Foster Child
Nephew
Niece
Grandchild
Grandparent
Parent
Brother
Sister
Aunt
Uncle
None
Other
Last Name
Is Dependent a Student?
Yes
No
Date of Birth
Is Dependent Disable?
Yes
No
Dependent 2
First Name
Social Security Number
Middle Name
Type of Relationship
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Son
Daughter
Step Child
Half Brother
Half Sister
Stepbrother
Stepsister
Foster Child
Nephew
Niece
Grandchild
Grandparent
Parent
Brother
Sister
Aunt
Uncle
None
Other
Last Name
Is Dependent a Student?
Yes
No
Date of Birth
Is Dependent Disable?
Yes
No
Dependent 3
First Name
Social Security Number
Middle Name
Type of Relationship
Select One...
Son
Daughter
Step Child
Half Brother
Half Sister
Stepbrother
Stepsister
Foster Child
Nephew
Niece
Grandchild
Grandparent
Parent
Brother
Sister
Aunt
Uncle
None
Other
Last Name
Is Dependent a Student?
Yes
No
Date of Birth
Is Dependent Disable?
Yes
No
Dependent 4
First Name
Social Security Number
Middle Name
Type of Relationship
Select One...
Son
Daughter
Step Child
Half Brother
Half Sister
Stepbrother
Stepsister
Foster Child
Nephew
Niece
Grandchild
Grandparent
Parent
Brother
Sister
Aunt
Uncle
None
Other
Last Name
Is Dependent a Student?
Yes
No
Date of Birth
Is Dependent Disable?
Yes
No
Dependent 5
First Name
Social Security Number
Middle Name
Type of Relationship
Select One...
Son
Daughter
Step Child
Half Brother
Half Sister
Stepbrother
Stepsister
Foster Child
Nephew
Niece
Grandchild
Grandparent
Parent
Brother
Sister
Aunt
Uncle
None
Other
Last Name
Is Dependent a Student?
Yes
No
Date of Birth
Is Dependent Disable?
Yes
No
W2 Return
Number of W2 Return
0
1
2
3
4
5
W2 Return 1
22222
VOID
Employee SSN
For Fofficial Only
OMB No. 1545-0008
Employer'S (EIN)
1 Wages, Tips, Other Compensation
Federal Income Tax Withheld
Employer's Name
Employer's Address
Employer's City
Employer's State
Employer's ZIP Code
Social Security Wages
Social Security Tax Withheld
Medicare Wages and Tips
Medicare Tax WIthheld
Social Security Tips
Allocated Tips
Verification Code
Dependent Care Benefits
Nonqualified Pians
12a Amount
12a Letter
Statutory Employee
Retirement Plan
Third-party Sick Pay
12c Amount
14 Other
12b Amount
12b Letter
12c Amount
12c Letter
12d Amount
12d Letter
Employer's State ID Number
State Wages, Tips, Etc
Local Wages, Tips, Etc
State Income Tax
Select State
Local Income Tax
Locality Name
Employer's State ID Number
State Wages, Tips, Etc
Local Wages, Tips, Etc
State Income Tax
Select State
Local Income Tax
Locality Name
Address / Misc.
Address
Cell Phone
Apartment
Cellular Provider
Select One...
ACS Alaska
ACS Wireless
AIO Wireless
Alltel
AT&T
Bellsouth
Bellsouth Mobility
Boost Mobile
Carolina West
CBeyond
Cellular One
Cellular One Texas
Cellular South
Cincinnati Bell
Cleartalk
Cricket(SMS)
Cricket(MMS)
CSpire
Edge
GCI
Google Voice
Go Smart Mobile
H20 Wireless
Inland
Metro PCS
Metro PCS 2
Mobileone
Mobi PCS
Nextel
Pocket
Project FI
Qwest Mobile
Republic Wireless
Simple Mobile
Sprint PCS
Surewest Comm
T-Mobile
Thumb
US Cellular
Verizon
StraightTalk
Page Plus Cellular
Virgin Mobile
Zip
How did you hear about us?
Select One...
Referral
Prior Client
City
Name of Referral
State
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AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District Of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Contact Information
Email Address
Company
Select One...
AffinityTax
East Side Office
Office
Select One...
Gabriel Flores
Preferred Location
Select One...
Joshua Flores
Becky Burns
Dan Burns
Payment Options
Payment Options
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Withhold Fees from Refund
Pay at Time of Filing
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Upload Additional Documents
Social Security Number
Please upload one or more files into the areas below. Uploads will accept JPG, PNG and PDF files only. You can select multiple files to upload for each section by Shift or Cmd/Ctrl clicking files in the prompt.
Upload W2 Forms
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File(s) uploaded
Upload 1099 Misc. Forms
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File(s) uploaded
Upload Social Security Card
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File(s) uploaded
Upload Driver License
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Upload Misc. Forms
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Upload Additional Forms
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