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Tax Return Drop Off Sheet

Miracle Mile Tax Service, Inc.


501 S.Fairfax Avenue                           Tel: (323) 933-1029 

Suite 102

Los Angeles, CA 90036                          Fax: (323) 933-1395      





Tax Return Drop Off Sheet

 

Date  _________________________

Time  _________________________

 

Name:________________________________________________________________________ 

Date of Birth:___________________________________________________________________

Occupation:____________________________________________________________________

Spouse Name: __________________________________________________________________

Spouse Date of Birth:_____________________________________________________________

Phone number to contact you:_____________________________________________________

Alternate Phone Number(s) _______________________________________________________

Is the address on the form W-2 correct?_______

If not, list correct address below

 

 

Dependents (or people living in your household you are claiming on your return)

Name_________________________________________________________________________

Date of Birth:___________________________________________________________________

Relationship to you:  _____________________________________________________________

Name_________________________________________________________________________

Date of Birth:___________________________________________________________________

Relationship to you:  _____________________________________________________________

Name_________________________________________________________________________

Date of Birth:___________________________________________________________________

Relationship to you:  _____________________________________________________________

Name_________________________________________________________________________

Date of Birth:___________________________________________________________________

Relationship to you:  _____________________________________________________________

 

Deductions (Please check all the deductions that apply)

 

____ Home Mortgage Interest                                      ____Real Estate

____ Charitable Contributions                                      ____ Child and Dependent Care Expenses

____ IRA contributions                                                  ____Medical Expenses

____ Personal Property Tax                                          ____ Casualty or Theft Loses

____ Employee business expense                                 ____ Moving Expenses

____ Student Loan Interest                                            ____ Other Miscellaneous Deductions

 

Additional Information

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


ĉ
Dan Leskowitz,
Nov 28, 2011, 3:31 PM
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