Income Tax Checklist Name (T) DOB (T) Social Security (T) Name (S) DOB (S) Social Security (S) Current Address City State Zip Code Contact NumberDependents Name Social Security DOB Relationship Dependents Name Social Security DOB Relationship Dependents Name Social Security DOB Relationship Dependents Name Social Security DOB Relationship Was everyone covered all year with Insurance? (explain)1095 - A?Yes For Everyone.Yes for some people on return (explain in notes)No, but insurance was provided by my work for everyone.No because we were not covered. Estimated Tax Payments:Dates Paid/Amounts Income:Types of Income (please provide us with forms as well) W-2 1099-DIV 1099-INT 1099-R 1099-SSA (Social Security) 1099-MISC W-2G (Gambling) 1099-G (Unemployment) PrintCAPTCHA Δ
