<p> Tel: 877-700-9110, Internet: www.PoliceTax.com, e-mail: [email protected] </p><p>Mail In Return Cover Sheet Fill in this cover sheet as best as possible. If you are an existing client, then we already have most of the information we are asking for. Just print this out and fill out any information that is new and fax in to the fax number above.</p><p>General</p><p>Filing Status 1=Single 2=HOH 3=MFJ 4=MFS 5=Qualified Widow</p><p>Taxpayer Info (T) Spouse Info (S) SS# SS# First Name First Name Last Name Last Name Occupation Occupation Are you a Dependant of Are you a Dependant of Someone else? Someone else? Date of Birth Date of Birth </p><p>Residence Home Phone Cell Phone Email Street Address City State Zip </p><p>Dependents First Name Last Name DOB SS# relationship 1 2 3 4 5 </p><p>Child & Dependent Care Provider Name Street Address City, State, Zip Phone # SS# or EIN Amount Paid Bank Info (For Direct Deposit) Routing Number Bank Name Account # Type of Acct (1-savings, 2- checking) </p><p>Income Interest Income Name of Bank Amount Name of Bank Amount</p><p>W2's, 1099's & Dividends (attach copy of forms)</p><p>Notes if any </p><p>State Income Tax Refund From the prior year </p><p>Other Income Amount Description</p><p>Itemized Expenses</p><p>Medical & Dental T/S Annual Total $ Description</p><p>Tax Expenses Property Taxes for Owner Occupied Home and/or Vacation Home (Not Rental Properties) Description Amount Description Amount</p><p>Personal Property (Vehicle Regsitration)) Description Amount Description Amount</p><p>IInterest Expense Home Mortgage Interest for Owner Occupied Home and/or Vacation Home (Not Rental Properties) Lender Amount Lender Amount</p><p>Charitable Expense Cash or Check Non-cash (donated goods i.e. Goodwill, Salvation Army Description Amount Description Amount</p><p>Misc Expense</p><p> tax preparation fee prior year </p><p>Education Student Loan Interest T/S/Dependant Description Amount</p><p>Tuition Fees 4=First Two years of College/University</p><p>5=Education after first two years Qualified T/S/Dep Ed Exp Code SS# First Name Last Name Amount</p><p>PoliceTax San Dimas, Long Beach, Valencia, Palmdale, Irvine Tel: 877-700-9110 www.PoliceTax.com e-mail: [email protected]</p>