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 _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ |
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