Name	First Name	Las Name
Address	Contact Address	Postal Address
State	Your State
City	City /Town
Zip	Zip Code
Email	Email.
Phone No	Cell Phone Number	Home / Office Phone No.
Filling Status	Status
Filling with Dependent	Choose an item.
Relationship to Dependent	Relation
Custody Right to Dependent	Choose an item.
Registered Company	Choose an item.
Registered Company Info	Company Name	Company EIN.
Itemized Deductions	Choose an item.
List of Itemized Deductions	List List List List List
Other Income	Choose an item.
Other Comment	Comment
Date	Date
Preparer Name
Signature

PREPARER AND CLIENT CONVERSATION