2016 Tax Organizer

Primary Taxpayer's Name *

Primary Taxpayer's Soc Sec # *

xxx-xx-xxxx

Primary Taxpayer's D.O.B. *

MM/DD/YYYY

Primary Tax Payer's Occupation *

Primary Taxpayer's Cell Phone *

Primary Taxpayer's Email Address *

Is the Primary Taxpayer?

Check all that apply:

Blind

Disabled

Widow(er)

Do you want to contribute $3 to the Pres. Campaign Fund?

Yes

No

Clear selection

If you receive a refund and would you like your funds direct deposited, please enter your bank's routing and account #.

Routing # 111900659, Account # 123456789