Data Sheet for W2 Filers
Fields marked with asterisk "*" are required.
Client Information
First Name:*
Middle Name:
Last Name:*
DOB:*
S.S. Number:*
Telephone#:*
Address1:*
Address2:
City:*
State:*
Zip Code:*
Occupation:
Email Address:
Sex:
Male
Female
Martial Status*
Choose One:
Select Marital Status
Single
Married
Widow(er)
Head of Household
Separated
Spouse Full Name:
Spouse S.S. Number:
Spouse Occupation:
Dependents
Name
SS#
DOB
1.
2.
3.
4.
Contribution of $3.00 to Presidential Election Campaign fund ?
No
Yes
Declaration
I attest that the above information and documentation provided to
Gabriel Daniel & Associates for "INCOME TAX PREPARATION"
is accurate and correct to the best of my knowledge.
Date:
©Copyright Gabriel Daniel & Associates, Inc
Another creation by
Advantage IT, Inc
