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GOAL GETTERS FINANCIAL TAX INFO SHEET

ALL INFORMATION GIVEN IS FOR INCOME TAX PURPOSES ONLY AND WILL BE KEPT CONFIDENTIAL

FOR BEST RESULTS PLEASE ACCESS THIS FORM ON A COMPUTER TO SEND YOUR TAX DOCUMENTS

Name (Nombre)

Email (Correo electronico)

Phone (Telefono celular)

Date of Birth (Fecha de nacimiento)

Gender

Social Security Number (Numero seguro social)

Address (Direccion)

Do you have any investments (stocks for example)

SPOUSE INFORMATION

Do you have a spouse?

Spouse's Name (Nombre de su pareja)

Spouse's Email (Correo electronico de su pareja)

Spouse's Phone (Telefono celular de su pareja)

Spouse's Date of Birth (Fecha de nacimiento de su pareja)

Spouse Gender

Spouse Social Security Number (Numero seguro social de su pareja)

DIRECT DEPOSIT INFORMATION

Bank Name (Nombre de banco)

Account Type (Cuenta)

Routing Number (Numero de routa)

Account Number (Numero de cuenta)

HEALTH INSURANCE INFORMATION

Did You have health insurance for the 2024 tax year? (Usted tenia seguro medico el ano 2024)

How did you obtain insurance? (Como obtuvo seguro)

DEPENDENT INFORMATION

Dependent one

1: Dependants Name (Nombre de Dependientes)

1: Date of Birth (Fecha de nacimiento)

1: Social Security Number ( Numero seguro social)

1: Relationship (Relacion)

Dependent two

2: Dependants Name (Nombre de Dependientes)

2: Date of Birth (Fecha de nacimiento)

2: Social Security Number ( Numero seguro social)

Dependent three

3: Dependants Name (Nombre de Dependientes)

3: Date of Birth (Fecha de nacimiento)

3: Social Security Number ( Numero seguro social)

3: Relationship (Relacion)

I consent that all information provided above is correct and up to date.

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Examples of documents include: W2, 1098, and 1099

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